Appropriate Medical Management Of Chronic Rhinosinusitis Reduces Use Of Antibiotics And Oral Corticosteroids

Objectives/Hypothesis Antibiotics and oral corticosteroids are used in the treatment of acute exacerbations of chronic rhinosinusitis (AECRS) and reflect poor disease control. We sought to characterize utilization of these systemic medications after appropriate medical management of chronic rhinosinusitis (CRS). Study Design Prospective observational study. Methods One hundred fifty patients undergoing medical management for CRS were studied. Data were collected at enrollment and follow-up 3 to 12 months later. All patients were asked to report the number of CRS-related antibiotics and oral corticosteroids used in the last 3 months. CRS symptom burden was measured using the 22-item Sino-Nasal Outcome Test (SNOT-22). Associations were sought between CRS-related antibiotics and oral corticosteroids use at follow-up compared to enrollment. Results From enrollment to follow-up, the mean number of CRS-related antibiotics courses used decreased by 0.2 courses (95% confidence interval [CI]: 0.1-0.4, P = .012), and the mean number of CRS-related oral corticosteroid courses used also decreased by 0.2 courses (95% CI: 0.1-0.3, P = .029). The number of CRS-related antibiotics used at follow-up was associated with CRS-related antibiotic use at enrollment (adjusted rate ratio [RR] = 1.58, 95% CI: 1.17-2.13, P = .003). The number of CRS-related oral corticosteroids used at follow-up was associated with reported CRS-related oral corticosteroid use at enrollment (adjusted RR = 3.20, 95% CI: 1.69-6.07, P < .001). SNOT-22 results at enrollment were also not predictive of future systemic medication use. Conclusions Appropriate medical management of CRS is associated with decreased use of oral antibiotics and corticosteroids. Previous utilization of antibiotics and oral corticosteroids for CRS is associated with future use of these medications. Level of Evidence 2c Laryngoscope, 2019