Antibiotic Treatment (Topical/Systemic)

The role of bacteria in the pathogenesis of chronic rhinosinusitis (CRS) is still controversial. As opposed to acute rhinosinusitis, CRS often exhibits polymicrobial infections with Gram-positive, Gram-negative, and anaerobic bacteria. Bacterial biofilms, intracellular residency, and exotoxins potentially contribute to the inflammatory processes of CRS. Interestingly, macrolide antibiotics have anti-inflammatory, immunomodulatory, antimucus, and antibacterial actions. There is robust evidence that long-term macrolide antibiotic treatment improves symptoms, decreases nasal polyp size, and reduces inflammatory markers in CRS. Furthermore, associated bronchial asthma seems to be improving in parallel with this treatment. In contrast, there is no clear evidence about the efficacy of topical intranasal or other systemic antibiotic agents in the treatment of CRS, but culture-directed short-course oral therapy may be considered on an individual basis.