Short-Term Broad-Spectrum Antibiotics
Three and even six-week courses were recommended for CRSsNP prior to surgery for many years, based primarily on uncontrolled cohort studies110. Currently, no recommendation is made for or against the use of antibiotics for CRS, given the lack of placebo-controlled studies and avoidance of antibiotic overuse111-113. CRSsNP was historically presumed to be the result of infection or secondary to biofilms, anaerobes or intracellular pathogens 13. Later work indicated alteration of the sinonasal microbiome rather than emergence of a specific pathogen14. Based on current dogma, the tissue endotype resulting from bacterial infection should presumably be T3, providing a theoretical rationale for the use of antibiotics in this setting(see Figure 2) 40. More recent studies on CRSsNP in Chicago have indicated that slightly over 50% of CRSsNP patient tissues exhibit at least a partial T2 endotype57. It is reasonable to expect that a properly selected group of CRS patients with T3 endotype, including polyp patients, would be more likely to respond to broad-spectrum antibiotics. A small prospective trial using 4 weeks of Augmentin documented objective and subjective improvement in the non-T2 CRS subset only114. It has also been proposed thatStaphylococcus aureus amplifies or causes T2 inflammation in a subset of CRS patients 115-117, but studies documenting efficacy of anti-staphylococcal antibiotics in association with a reduction in this bacterium in the tissue have not been performed to date.