Boston, MA: Antibiotics are not required after most endoscopic sinus surgery (ESS), finds a recent study in the journal IFAR: International Forum of Allergy & Rhinology. According to the study, there were no significant differences in postoperative rates of infection or endoscopic scores in the antibiotic and placebo group. However, the rate of diarrhea was found to be significantly higher in the antibiotic group.
The findings suggest that routine use of prophylactic postoperative antibiotics does nothing in improving post-EES outcomes and instead increases the rate of diarrhea.
Prophylactic antibiotics are often prescribes after EES, yet not much data exists to support this practice. In this study by Eric H. Holbrook, Harvard Medical School, Boston, MA, and colleagues aimed to assess the impact of post‐ESS antibiotics on infection, quality of life (QOL), and endoscopic scores.
For the purpose, the researchers performed a randomized, double‐blind, placebo‐controlled, noninferiority trial comparing amoxicillin‐clavulanate vs placebo after ESS. It included 77 adults with chronic rhinosinusitis (CRS) refractory to appropriate medical therapy who underwent ESS. They were randomized to receive either antibiotics (N = 37) or placebo (N = 40) and were followed clinically.
QOL was measured with 22‐item Sino‐Nasal Outcome Test questionnaires and Lund‐Kennedy endoscopic scores were evaluated at baseline and follow-up. Outcomes were analyzed with repeated‐measures analysis of variance and analysis of covariance and z tests for proportions.
Key findings of the study include:
Placebo was noninferior to antibiotic prophylaxis with regard to postoperative SNOT‐22 scores (β = 0.18, 2‐tailed).
There were no significant differences between the antibiotic and placebo groups in LK score trajectories over time or in postoperative infection rates (2.6% vs 2.4%, respectively).
The rate of diarrhea was significantly higher in the antibiotic group (24.3% vs 2.5%; relative risk = 10.8).
"These findings add to the growing evidence that routine use of prophylactic postoperative antibiotics does not improve outcomes post‐ESS and significantly increases the rate of diarrhea," concluded the authors.
The study titled, "Prophylactic antibiotics after endoscopic sinus surgery for chronic rhinosinusitis: a randomized, double‐blind, placebo‐controlled noninferiority clinical trial," is published in the IFAR: International Forum of Allergy & Rhinology.
DOI: https://onlinelibrary.wiley.com/doi/10.1002/alr.22756