Antibiotics are not necessary for patients after most routine endoscopic sinus surgeries despite the common practice of prescribing them, according to a team led by researchers at Massachusetts Eye and East.
In a new randomized controlled trial, patients who underwent endoscopic sinus surgery had no differences including symptoms and diseases whether they took an antibiotic or a placebo after surgery.
The only reported difference in outcomes was side effects, with patients in the antibiotic group 10 times more likely to report symptoms such as diarrhea.
The results of the trial were published December 19 in IFAR: International Allergy & Rhinology Forum.
For routine sinus surgery, antibiotics are not needed and may cause more complications such as gastrointestinal side effects. There have been studies that suggest that antibiotics may or may not help, and we tried to clear that up through a randomized controlled trial. “
Eric H. Holbrook, MD, Co-study Senior Author and Director of the Department of Rhinology, Eye and Ear Mass and Associate Professor of Head and Neck Surgery Otolaryngology, Harvard School of Medicine
A randomized trial compared antibiotics with placebo
The researchers began a placebo-controlled randomized trial in 2013 when they began enrolling patients at Eye and Ear Mass receiving uncomplicated endoscopic sinus surgery. Patients with no evidence of active disease during surgery were randomized to receive a one-week regimen of antibiotic or placebo thereafter.
A total of 77 patients (out of 134 enrolled) who met the study criteria were included in the final analysis: 37 received antibiotics and 40 did not. Patients were examined one week and six weeks after surgery.
Patients in both groups reported improvements in sinus symptoms after surgery, however, no statistically significant differences were reported in levels of infectious nasal symptoms between the two groups. More than 24 percent of patients in the antibiotic group reported diarrhea compared with 2.5 percent in the placebo group.
Although previous studies have looked at this issue of the utility of antibiotics after sinus surgery, there was little mixed data. This is the first study that used a randomized trial to evaluate antibiotics for a one-week treatment period on well-tested patient outcomes.
“Our findings suggest that otolaryngologists may reconsider prescribing antibiotics routinely after endoscopic sinus surgery,” said co-lead study author Stacey T. Gray, MD, director of the Sinus Center at Mass Eye and Ear and Associate Professor of Otolaryngology- Head and Neck Surgery at Harvard School of Medicine.
“Antibiotics should still be considered when the benefits outweigh the risks, including complex surgical procedures or if the patient is at increased risk for developing an infection.”
Antibiotics are often prescribed after sinus surgery without evidence
More than 250,000 sinus surgeries occur each year for the treatment of harmful sinus infections that do not respond to other medical treatments.
In endoscopic sinus surgery, a range of implants and surgical instruments are inserted into the nose to widen or open the normal drainage pathways that connect the sinuses to the nasal cavity. For people with chronic or recurrent infections, these openings can be too swollen for proper drainage.
It has long been debated whether antibiotics are routinely required immediately after endoscopic sinus surgery to reduce the risk of postoperative diseases and reduce inflammation and increase patient outcomes. Most sinus surgeons surveyed in previous studies said they were given antibiotics after the operation.
Antibiotic resistance has long been a concern throughout health care, especially when treating sinus infections. Unnecessary antibiotic prescriptions can also increase health care costs and affect quality of life due to associated side effects.
This study only looked at conventional endoscopic sinus surgery and not those that use a removable nasal pack, which may be a field of study in the future.
Source:
Massachusetts Eye and Ear Hospital
Magazine Reference:
Lehmann, EU, et al. (2020) prophylactic antibiotics after endoscopic sinus surgery for chronic rhinosinusitis: a randomized, double-blind, placebo-controlled clinical trial. Allergy and Rhinology International Forum. doi.org/10.1002/alr.22756.