Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Int Forum Allergy Rhinol. 2013 Jan;3(1):31-47. doi: 10.1002/alr.21064. Epub 2012 Jun 26.
Chronic rhinosinusitis (CRS) is characterized by inflammation of the mucosa of the nose and paranasal sinuses. The role of bacterial or fungal infection in CRS is unclear, yet antimicrobials are commonly prescribed for this condition. Published guidelines offer little direction regarding antibiotic strategies for CRS. The purpose of this article is to provide an evidence-based approach to the use of antibacterial and antifungal antibiotics in the management of CRS.
A systematic review of the literature was performed following recommendations of the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE). Inclusion criteria were: age ≥18 years old, chronic rhinosinusitis with or without polyps, antibiotic treatment as the experimental group, and clearly defined primary clinical endpoint. Studies involving patients with cystic fibrosis or acute invasive fungal sinusitis were excluded.
The review identified and evaluated the literature on 8 classes of antimicrobials for CRS: oral antibacterial antibiotics ≤3 weeks, oral antibacterial antibiotics >3 weeks, macrolide antibiotics, intravenous antibacterial antibiotics, topical antibacterial antibiotics, oral antifungals, intravenous antifungals, and topical antifungals.
Based on the available evidence, oral antibacterial antibiotics and prolonged macrolide antibiotics are considered therapeutic options in the treatment of CRS while the use of topical antibacterial antibiotics, intravenous antibacterial antibiotics and oral, topical, or intravenous antifungals would be recommended against. These evidence-based recommendations should not necessarily be applied to all patients with CRS and are not intended to supersede clinical judgment based on individual patient circumstances.
慢性鼻-鼻窦炎（CRS）的特征为鼻黏膜和鼻旁窦的炎症。细菌或真菌感染在 CRS 中的作用尚不清楚，但仍常为该病开具抗菌药物。已发表的指南针对 CRS 的抗生素策略提供的指导甚少。本文旨在为抗菌和抗真菌抗生素在 CRS 管理中的应用提供一种基于证据的方法。
根据临床实践指南手册、指南标准化会议（COGS）和评估指南和研究评价（AGREE）的建议，对文献进行系统评价。纳入标准为：年龄≥18 岁，伴或不伴息肉的慢性鼻-鼻窦炎，抗生素治疗为实验组，且有明确的主要临床终点。排除涉及囊性纤维化或急性侵袭性真菌性鼻窦炎患者的研究。
该综述确定并评估了 8 类用于 CRS 的抗生素的文献：口服抗菌抗生素≤3 周，口服抗菌抗生素>3 周，大环内酯类抗生素，静脉用抗菌抗生素，局部用抗菌抗生素，口服抗真菌药，静脉用抗真菌药和局部用抗真菌药。
基于现有证据，口服抗菌抗生素和延长疗程的大环内酯类抗生素被认为是 CRS 治疗的选择，而局部用抗菌抗生素、静脉用抗菌抗生素以及口服、局部或静脉用抗真菌药则被推荐用于对抗。这些基于证据的建议不一定适用于所有 CRS 患者，也不应取代基于个体患者情况的临床判断。
