Russell Paul T, Bekeny James Russell
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Curr Opin Otolaryngol Head Neck Surg. 2014 Feb;22(1):22-6. doi: 10.1097/MOO.0000000000000022.
Chronic rhinosinusitis affected 12.5% of the general population in the United States, making it one of the most common causes for patients to seek medical care. Despite a lack of compelling evidence, antibiotics are the most frequently prescribed class of medications for the treatment of chronic sinusitis, demonstrating a deeply rooted belief that bacteria are in some way responsible for the disease.
Despite the high prevalence of sinusitis, the cause of chronic rhinosinusitis remains elusive despite multiple attempts to determine the underlying cause. Theories have come and gone throughout the years with fungi, bacteria, host immunological defects, allergy, structural and functional defects, gastroesophageal reflux disease, environmental chemicals, and bacterial biofilms being blamed for this chronic inflammatory state of the sinonasal mucosa. Recent literature has continued to explore these various theories.
To date, there is no high-quality evidence that antibiotic therapy has any effect on the long-term management of chronic rhinosinusitis. No randomized placebo-controlled studies evaluating the utility of antibiotics have as yet been conducted. There remains an urgent need for a high-quality, prospective clinical trial to determine the proper role of antibiotics in the treatment of chronic rhinosinusitis.
在美国，慢性鼻窦炎影响着12.5%的普通人群，使其成为患者寻求医疗护理的最常见原因之一。尽管缺乏确凿证据，但抗生素是治疗慢性鼻窦炎最常处方的药物类别，这表明人们根深蒂固地认为细菌在某种程度上是该疾病的病因。
尽管鼻窦炎患病率很高，但尽管多次尝试确定潜在病因，慢性鼻窦炎的病因仍不清楚。多年来，各种理论层出不穷，真菌、细菌、宿主免疫缺陷、过敏、结构和功能缺陷、胃食管反流病、环境化学物质以及细菌生物膜都被认为是鼻窦黏膜这种慢性炎症状态的罪魁祸首。最近的文献继续探讨这些各种理论。
迄今为止，没有高质量的证据表明抗生素治疗对慢性鼻窦炎的长期管理有任何效果。尚未进行评估抗生素效用的随机安慰剂对照研究。迫切需要进行一项高质量的前瞻性临床试验，以确定抗生素在慢性鼻窦炎治疗中的恰当作用。
