Department of Otolaryngology, West Suffolk Hospital, Bury St Edmunds, UK.
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Am J Rhinol Allergy. 2021 Sep;35(5):700-712. doi: 10.1177/1945892421989142. Epub 2021 Jan 24.
Endoscopic sinus surgery is performed for medically recalcitrant chronic rhinosinusitis. There is no universally accepted strategy regarding post-operative antibiotics despite the high rates of usage worldwide. The aim of this study was to analyse patient-reported and objective outcomes behind antibiotic use following endoscopic sinus surgery.
A search of electronic databases was performed. Eligible randomised controlled trials (RCTs) and observational trials were included. The primary outcome was patient reported outcome measures. Secondary outcomes were local infections, endoscopy scores and adverse events. Meta-analysis was performed.
Of 1045 publications identified, 7 were included in the qualitative synthesis and 5 RCTs were included in meta-analysis. Antibiotic regimens varied between studies in terms of antibiotic selection, timing commenced and duration of use. Meta-analysis suggested no significant difference between placebo and antibiotics in patient reported outcome measures (standardised mean difference (SMD) -0.215, 95% confidence interval (CI) -0.637 to 0.207) or endoscopic scores (SMD -2.86, 95% CI -0.846 to 0.273). There was no consistent definition in reporting of infection; therefore, this outcome cannot be comprehensively considered. No severe adverse events were attributable to antibiotics.
From the studies analysed, there is no level 1 evidence to suggest that antibiotics improved patient outcomes following sinus surgery. However, there was significant heterogeneity in outcome measures and no clear data exists regarding the effects of antibiotics on postoperative infections. The available evidence at present is not enough to make a recommendation in either direction. Further designed larger RCTs are required to investigate these questions in more detail.
内镜鼻窦手术用于治疗医学上难以治疗的慢性鼻-鼻窦炎。尽管全球使用率很高，但术后使用抗生素仍没有被普遍接受的策略。本研究旨在分析内镜鼻窦手术后使用抗生素背后的患者报告和客观结果。
对电子数据库进行了检索。纳入了合格的随机对照试验（RCT）和观察性试验。主要结局是患者报告的结果测量。次要结局是局部感染、内镜评分和不良事件。进行了荟萃分析。
在确定的 1045 篇文献中，有 7 篇被纳入定性综合分析，5 项 RCT 被纳入荟萃分析。抗生素方案在抗生素选择、开始时间和使用持续时间方面在研究之间存在差异。荟萃分析表明，在患者报告的结果测量（标准化均数差（SMD）-0.215，95%置信区间（CI）-0.637 至 0.207）或内镜评分（SMD-2.86，95%CI-0.846 至 0.273）方面，安慰剂和抗生素之间无显著差异。关于感染的报告没有统一的定义；因此，这个结果不能全面考虑。没有抗生素相关的严重不良事件。
从分析的研究来看，没有一级证据表明抗生素可以改善鼻窦手术后患者的结果。然而，结果测量存在很大的异质性，并且关于抗生素对术后感染的影响，目前没有明确的数据。目前的证据还不足以在任何方向上做出推荐。需要进一步设计更大规模的 RCT 来更详细地研究这些问题。
