Bhattacharyya Neil
Harvard Medical School, Division of Otolaryngology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115, USA.
Curr Allergy Asthma Rep. 2009 May;9(3):221-6. doi: 10.1007/s11882-009-0032-3.
Antimicrobial therapy has been a mainstay of treatment for chronic rhinosinusitis (CRS). The roles of bacterial and fungal infection in the primary pathogenesis of CRS recently have been called into question. Although many different bacteria and fungi can be isolated from CRS patients, antimicrobial treatment directed at their eradication has met with mixed clinical results. Overall, macrolide antibiotics hold the most promise before surgery. Topical antibiotics are safe, efficient, and effective for treating acute bacterial exacerbations of CRS after endoscopic sinus surgery and may prevent the development of subsequent bacterial resistance. Topical treatment of CRS with antifungal agents both before and after sinus surgery is of limited benefit and should not be considered as a primary treatment modality before surgery. Further research into the role of bacterial and fungal infection in the pathophysiology of CRS may offer better insights into appropriate antimicrobial choices, dosing, and treatment duration.
抗菌治疗一直是慢性鼻-鼻窦炎（CRS）治疗的主要手段。细菌和真菌感染在CRS原发性发病机制中的作用最近受到了质疑。尽管可以从CRS患者中分离出许多不同的细菌和真菌，但针对根除这些病菌的抗菌治疗临床效果不一。总体而言，大环内酯类抗生素在手术前最具前景。局部使用抗生素对内窥镜鼻窦手术后CRS的急性细菌感染加重期治疗安全、高效且有效，还可预防后续细菌耐药性的产生。鼻窦手术前后使用抗真菌药物局部治疗CRS的益处有限，术前不应将其视为主要治疗方式。进一步研究细菌和真菌感染在CRS病理生理学中的作用，可能会为合适的抗菌药物选择、剂量及治疗时长提供更好的见解。
