No antibiotics needed after most sinus surgery: randomized controlled trials

Despite the common practice of prescribing antibiotics, patients after most routine endoscopic sinus surgery do not need antibiotics, according to a team led by researchers at Massachusetts Eye and Year.

In a new randomized controlled trial Endoscopic sinus surgery There was no difference in symptoms, infections, etc., regardless of whether they later took antibiotics or placebo. Surgery..The only reported difference in results is Side effectsPatients in the antibiotic group are 10 times more likely to report symptoms such as diarrhea.

The results of the trial were released on December 19th IFAR: International Forum on Allergy and Nasal Science..

“For regular sinus surgery Antibiotics It is unnecessary and can cause complications such as gastrointestinal side effects, “said Eric H. Holbrook, MD, Associate Professor of Otorhinolaryngology, Harvard Medical School. I am. “There were studies suggesting that antibiotics may or may not help, and we sought to clarify it through rigorous randomized trials.”

Randomized trials comparing antibiotics and placebo

Researchers embarked on a randomized, placebo-controlled trial in 2013 when they began enrolling patients with Mass Eye and Ear undergoing uncomplicated endoscopic sinus surgery.Patients without active evidence infection During surgery, they were randomized to receive a weekly regimen of antibiotics or placebo.

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 1 and 6 weeks after surgery.

Patients in both groups reported improvement in sinus symptoms after surgery, but no statistically significant difference was reported in the proportion of infected nasal symptoms between the two groups.24% or more of patient Diarrhea was reported in the antibiotic group, compared with 2.5% in the placebo group.

Previous studies have addressed this issue of the usefulness of antibiotics after sinus surgery, but have minimal mixed data. This is the first study to use a randomized trial to evaluate antibiotics over a one-week treatment period for well-validated patient outcomes.

“Our findings suggest that otolaryngologists can rethink the practice of routinely prescribing antibiotics after endoscopic sinus surgery,” said Maseye, co-lead author of the study. Dr. Stacy T. Gray, director of the Andyer Vice Nose Center and associate professor of otolaryngology, said. Head and neck surgery at Harvard Medical School. “If the benefits outweigh the risks, such as complex surgical procedures, or if the patient is at high risk of developing an infection, antibiotics should continue to be considered.”

Antibiotics often prescribed without evidence after sinus surgery

More than 250,000 sinus surgeries are performed each year to treat chronic sinus infections that do not respond to other treatments. In endoscopic sinus surgery, a scope and surgical instruments are inserted into the nose to widen or open the normal drainage pathway that connects the sinuses to the nasal cavity. For people with chronic or recurrent infections, these openings may be too swollen to allow proper drainage.

It has long been debated whether antibiotics are routinely needed immediately after endoscopic sinus surgery to reduce the risk of postoperative infection, reduce swelling, and optimize patient outcomes. The majority of sinus surgeons investigated in previous studies reported that they received antibiotics postoperatively.

Antibiotic resistance is a long-standing concern Health careEspecially when treating sinus infections.Unnecessary antibiotic prescriptions may also increase Medical bills It affects quality of life due to related side effects.

This study only covers routine endoscopic sinus surgery, not those that use soluble nasal packing.