Woźniak A, Nowak K, Wnuk J, Kaczmarczyk J, Król P, Stręk P, Składzień J, Szaleniec J
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
J Laryngol Otol. 2021 Dec;135(12):1088-1093. doi: 10.1017/S0022215121002759. Epub 2021 Oct 6.
Antibiotics are the mainstay of therapy for acute exacerbation of chronic rhinosinusitis. However, no treatment guidelines exist. Most clinicians follow the recommendations for acute bacterial rhinosinusitis, usually caused by , or , and treat with amoxicillin or amoxicillin-clavulanate.
Medical data of 810 patients who had undergone endoscopic sinus surgery were analysed retrospectively. The results of bacterial cultures and treatment course were assessed in 152 patients who presented with acute exacerbation of chronic rhinosinusitis within 6 months of endoscopic sinus surgery.
The most common bacterial species present were (36 per cent), (13 per cent) and (11 per cent). Most of the isolates showed resistance or intermediate sensitivity to amoxicillin-clavulanate. Targeted antibiotic therapy was significantly more effective than empiric therapy (71 per cent versus 42 per cent). The most effective antibiotics were fluoroquinolones.
Acute exacerbation of chronic rhinosinusitis shows different microbiology than acute bacterial rhinosinusitis and requires a different therapeutic approach. It is optimally treated with culture-directed antibiotic therapy.
抗生素是慢性鼻-鼻窦炎急性加重期治疗的主要手段。然而，目前尚无治疗指南。大多数临床医生遵循针对通常由肺炎链球菌、流感嗜血杆菌或卡他莫拉菌引起的急性细菌性鼻-鼻窦炎的推荐方案，使用阿莫西林或阿莫西林-克拉维酸进行治疗。
对810例行鼻内镜鼻窦手术患者的医疗数据进行回顾性分析。对152例在鼻内镜鼻窦手术后6个月内出现慢性鼻-鼻窦炎急性加重的患者的细菌培养结果和治疗过程进行评估。
最常见的细菌种类为肺炎链球菌（36%）、流感嗜血杆菌（13%）和卡他莫拉菌（11%）。大多数分离菌株对阿莫西林-克拉维酸表现出耐药或中度敏感。针对性抗生素治疗明显比经验性治疗更有效（71%对42%）。最有效的抗生素是氟喹诺酮类。
慢性鼻-鼻窦炎急性加重期的微生物学特征与急性细菌性鼻-鼻窦炎不同，需要不同的治疗方法。采用基于培养结果的抗生素治疗最为理想。
