PMID- 29782068
OWN - NLM
STAT- MEDLINE
DCOM- 20190919
LR  - 20190919
IS  - 2042-6984 (Electronic)
IS  - 2042-6976 (Linking)
VI  - 8
IP  - 9
DP  - 2018 Sep
TI  - Comparison of outcomes following culture-directed vs non-culture-directed 
      antibiotics in treatment of acute exacerbations of chronic rhinosinusitis.
PG  - 1028-1033
LID - 10.1002/alr.22147 [doi]
AB  - BACKGROUND: Acute exacerbations in patients with chronic rhinosinusitis (CRS) are 
      often treated with courses of systemic antibiotics. Poor correlation between 
      microbiologic culture results and the sinus microbiome in CRS has caused 
      increased debate as to the relevance of culture-directed antibiotics. There is 
      currently sparse data comparing outcomes of culture-directed antibiotics vs 
      non-culture-directed antibiotics for treatment of CRS. METHODS: This work reports 
      a retrospective review. A total of 946 CRS patients treated with antibiotics were 
      examined; 122 CRS patients with acute exacerbations were treated with 
      culture-directed (n = 61) vs empiric (n = 61) antibiotics. Lund-Kennedy (LK) and 
      22-item Sino-Nasal Outcome Test (SNOT-22) scores were compared pretreatment and 
      posttreatment, with short-term (<1 month) and long-term (1-6 months) follow-up. 
      Patient demographics, comorbidities, and prior surgical history were collected. 
      RESULTS: Both groups had similar pretreatment SNOT-22 scores (p = 0.25) while the 
      culture group had higher baseline LK endoscopy scores (p < 0.01). All data were 
      adjusted for pertinent comorbidities, surgical history, co-therapeutics, and 
      baseline scores. There was no difference in improvement in culture-directed and 
      empirically treated groups in the short-term (p = 0.77) and long-term (p = 0.58) 
      for minimal clinically important difference (MCID) of SNOT-22 and no difference 
      in the short-term for LK scores (p = 0.11), but there was significantly more 
      improvement in long-term LK scores in the culture-directed group (p = 0.01). 
      CONCLUSION: Culture-directed therapy improves long-term endoscopy scores but does 
      not yield an advantage in improving short-term endoscopy scores, nor in improving 
      short-term and long-term quality of life scores in CRS patients. A prospective 
      study is necessary to examine the relevance of routine microbiologic cultures in 
      CRS patients.
CI  - (c) 2018 ARS-AAOA, LLC.
FAU - Yan, Carol H
AU  - Yan CH
AUID- ORCID: 0000-0003-1934-4922
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University, 
      Stanford, CA.
FAU - Tangbumrungtham, Navarat
AU  - Tangbumrungtham N
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University, 
      Stanford, CA.
AD  - Department of Otorhinolaryngology, Ramathibodi Hospital, Bangkok, Thailand.
FAU - Maul, Ximena A
AU  - Maul XA
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University, 
      Stanford, CA.
AD  - Department of Otolaryngology, Pontificia Universidad Catolica de Chile, Santiago, 
      Chile.
FAU - Ma, Yifei
AU  - Ma Y
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University, 
      Stanford, CA.
FAU - Nayak, Jayakar V
AU  - Nayak JV
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University, 
      Stanford, CA.
FAU - Hwang, Peter H
AU  - Hwang PH
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University, 
      Stanford, CA.
FAU - Patel, Zara M
AU  - Patel ZM
AUID- ORCID: 0000-0003-2072-982X
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University, 
      Stanford, CA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20180521
PL  - United States
TA  - Int Forum Allergy Rhinol
JT  - International forum of allergy & rhinology
JID - 101550261
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Bacteria/*isolation & purification
MH  - Chronic Disease
MH  - Drug Utilization Review
MH  - Endoscopy
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Paranasal Sinuses/microbiology/pathology/surgery
MH  - Quality of Life
MH  - Retrospective Studies
MH  - Rhinitis/*diagnosis/*drug therapy/pathology/surgery
MH  - Sinusitis/*diagnosis/*drug therapy/pathology/surgery
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Lund-Kennedy
OT  - SNOT-22
OT  - antibiotic
OT  - chronic rhinosinusitis
OT  - culture
OT  - exacerbation
OT  - infection
OT  - quality of life
OT  - therapeutics
EDAT- 2018/05/22 06:00
MHDA- 2019/09/20 06:00
CRDT- 2018/05/22 06:00
PHST- 2018/03/03 00:00 [received]
PHST- 2018/04/23 00:00 [revised]
PHST- 2018/05/03 00:00 [accepted]
PHST- 2018/05/22 06:00 [pubmed]
PHST- 2019/09/20 06:00 [medline]
PHST- 2018/05/22 06:00 [entrez]
AID - 10.1002/alr.22147 [doi]
PST - ppublish
SO  - Int Forum Allergy Rhinol. 2018 Sep;8(9):1028-1033. doi: 10.1002/alr.22147. Epub 
      2018 May 21.