Antibiotic Treatment for Chronic Rhinosinusitis: Prescription Patterns and Associations with Patient Outcome and the Sinus Microbiota
Authors List
Lux, C.A., School of Biological Sciences, University of Auckland, Auckland, New Zealand
Wagner Mackenzie, B., Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
Johnston, J., Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
Zoing, M., Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
Biswas, K., Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
Tayler, M.W., School of Biological Sciences, University of Auckland, Auckland, New Zealand
Douglas, R.G., Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
Introduction: Chronic rhinosinusitis (CRS) is a common and debilitating inflammatory condition of the sinuses, afflicting 5% of the general population. Although antibiotics are frequently prescribed for the medical management of CRS, there is surprisingly little evidence to support their efficacy.
Aims: In this meta-analysis, we aimed to establish associations between medication usage, the sinus bacterial community and patients’ clinical outcomes.
Methods: Antibiotic prescription patterns for the year before sample collection of 156 CRS patients, 45 disease control patients (mostly requiring septoplasty and inferior turbinate reduction) and 35 healthy control subjects were examined and correlated with previously published bacterial 16S rRNA gene amplicon data from our group.
Results: The highest usage was observed among the two patient categories. Despite heavy antibiotic usage, CRS patients’ clinical outcomes as indicated by patient questionnaires and radiologic scores were similar to those patients that did not receive any antibiotics. The sinus microbiota was dominated by members of the bacterial genera Corynebacterium and Staphylococcus in all three cohorts. Bacterial community dispersion as measured by principal coordinate analysis was significantly higher in CRS patients compared to healthy control subjects, but not disease control patients. Pairwise comparisons within cohorts revealed differences in the relative 16S rRNA gene sequence abundances of the genera Staphylococcus and Lawsonella between antibiotic users and non-users. However, overall antibiotic effects were minimal and unpredictable.
Conclusion: The unpredictable effects of antibiotic treatment on the sinus microbiota found in this study, together with the lack of differences in patients’ symptom scores between cohorts, do not support preoperative antibiotic treatment for CRS patients. More effective treatment strategies are required so that patients are not unnecessarily exposed to the risks of antibiotics, including the development of resistance.
Lux, C.A., School of Biological Sciences, University of Auckland, Auckland, New Zealand
Wagner Mackenzie, B., Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
Johnston, J., Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
Zoing, M., Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
Biswas, K., Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
Tayler, M.W., School of Biological Sciences, University of Auckland, Auckland, New Zealand
Douglas, R.G., Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
Introduction: Chronic rhinosinusitis (CRS) is a common and debilitating inflammatory condition of the sinuses, afflicting 5% of the general population. Although antibiotics are frequently prescribed for the medical management of CRS, there is surprisingly little evidence to support their efficacy.
Aims: In this meta-analysis, we aimed to establish associations between medication usage, the sinus bacterial community and patients’ clinical outcomes.
Methods: Antibiotic prescription patterns for the year before sample collection of 156 CRS patients, 45 disease control patients (mostly requiring septoplasty and inferior turbinate reduction) and 35 healthy control subjects were examined and correlated with previously published bacterial 16S rRNA gene amplicon data from our group.
Results: The highest usage was observed among the two patient categories. Despite heavy antibiotic usage, CRS patients’ clinical outcomes as indicated by patient questionnaires and radiologic scores were similar to those patients that did not receive any antibiotics. The sinus microbiota was dominated by members of the bacterial genera Corynebacterium and Staphylococcus in all three cohorts. Bacterial community dispersion as measured by principal coordinate analysis was significantly higher in CRS patients compared to healthy control subjects, but not disease control patients. Pairwise comparisons within cohorts revealed differences in the relative 16S rRNA gene sequence abundances of the genera Staphylococcus and Lawsonella between antibiotic users and non-users. However, overall antibiotic effects were minimal and unpredictable.
Conclusion: The unpredictable effects of antibiotic treatment on the sinus microbiota found in this study, together with the lack of differences in patients’ symptom scores between cohorts, do not support preoperative antibiotic treatment for CRS patients. More effective treatment strategies are required so that patients are not unnecessarily exposed to the risks of antibiotics, including the development of resistance.
