Table I:
Summary of Recent Guideline Recommendations Regarding Antibiotic Treatment of CRS
| Guideline | Level of evidence/Grade | Recommendations and Key Excerpts |
|---|---|---|
| ICAR, 2021(15) | B | Option: Macrolides for patients with CRSsNP. Optimal drug, dosage, and treatment duration are not known. Option: Macrolides are likely beneficial in CRSwNP. Optimal drug, dosage and treatment duration are not known. Recommendation against non-macrolide antibiotics (<3 weeks) should generally not be prescribed for CRSwNP except in acute exacerbations |
| EPOS, 2020(13) | 1b (−) | Recommendation against antibiotics for diffuse, bilateral CRS in the primary care setting. EPOS 2020 acknowledges international variations in recommendations, and the steering group “is uncertain” whether or not the use of a short course of antibiotics has an impact on patient outcomes. |
| 1a (−) | Option: long term antibiotics for patients with CRSsNP and CRSwNP. The EPOS 2020 steering group “is uncertain” whether or not the use of long-term antibiotics has an impact on patient outcomes. |
|
| CSA/CSO, 2020(16) | Not specified | Recommendation: long-term, low-dose macrolide therapy for CRSsNP patients with neutrophilic inflammatory patterns and low IgE levels. Recommendation: Long-term, low-dose macrolide therapy for corticosteroid-resistant CRSwNP patients, neutrophil-dominant NPs, persistent edema of the nasal mucosa, and purulent nasal discharge. “Currently, there is no evidence supporting the use of CRS (CRSsNP and CRSwNP) patients with (non-macrolide) antibiotic therapy in CRSsNP or CRSwNP.” |
| CPGAS, 2015(18) | Not specified | Recommendation: antibiotic treatment for acute exacerbations of CRS and for patients with persistent purulent drainage. Option: Some patients with CRSsNP may benefit from prolonged antibiotic treatment. |
| JTFPP, 2014(17) | A | Option: antibiotics plus a short course of oral corticosteroids in the treatment of CRS. A greater benefit with antibiotics has been reported in CRSsNP than in CRSwNP. Recommendation: >10–14 days of antibiotic therapy for CRS associated with suspected bacterial infection; the choice of antibiotic therapy may need to consider the possible presence of anaerobic pathogens. |
CPGAS = Clinical practice guideline (update): adult sinusitis; CSA/CSO = Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline; EPOS = European Position Paper on Rhinosinusitis and Nasal Polyps 2020; ICAR = International consensus statement on allergy and rhinology: rhinosinusitis 2021; JTFPP = Diagnosis and management of rhinosinusitis: a practice parameter update (from the Joint Task Force on Practice Parameters)