Cincinnati, OH—Here’s a way to avoid the need for antibiotics and oral steroids in patients with chronic rhinosinusitis (CRS): Consistent and appropriate use of nasal saline and corticosteroid sprays.

That’s according to a study in Laryngoscope. A group of international researchers conducted a study of 150 patients at Massachusetts Eye and Ear undergoing medical management for CRS and determined that CRS-related use of oral steroids and antibiotics dropped by 0.2 courses per 3-month period on average. That translates to about one less course of antibiotics and oral steroids in a year to deal with severe symptoms of CRS.

“We found that the use of the sprays or irrigations improved antibiotics and oral steroids usage by closer to three-to-four courses per year, on average, which is a huge effect,” explained coauthor Ahmad Sedaghat, MD, PhD, an ear, nose and throat specialist at the University of Cincinnati College of Medicine. “Medication usage was reduced by one course every three-to-four months. The medical therapy we provided in the form of intranasal saline and intranasal steroids dramatically cut down on the usage of systemic antibiotics and steroids.”

Dr. Sedaghat points out that antibiotics have gastric and intestinal side effects and lead to body resistance, while long-term use of steroids can cause mood disturbance, insomnia, weight gain, diabetes, cataracts and other problems, adding, “We really want to minimize the use of these medications.”

Researchers explain that use of antibiotics and oral corticosteroids in the treatment of acute exacerbations of chronic rhinosinusitis reflect poor disease control.

For their prospective observational study, 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, and CRS symptom burden was measured using the 22-item Sino-Nasal Outcome Test (SNOT-22).

The study team sought to determine associations between CRS-related antibiotics and oral corticosteroids use at follow-up, compared with enrollment.

The study team determined that, from enrollment to follow-up, the mean number of CRS-related antibiotics courses used decreased by 0.2 courses (95% 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).

Furthermore, the study found that 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), and that 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,” the authors note, adding, “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.”

When researchers focused on the about 40 patients requiring oral steroids and the 33 needing antibiotics, they found that the use of antibiotics for CRS dropped by 40% while the use of oral steroids associated with CRS decreased by 67%, Dr. Sedaghat said.

“If you simply treat patients regularly and consistently with what we call appropriate medical management, and that means staying on top of them and making sure these patients are using their sprays every single day, these patients will have dramatically fewer problems,” he advised.

The four main symptoms of CRS are nasal obstruction, nasal drainage, facial pain, or pressure and decreased sense of smell. Patients need to have two out of four of these symptoms for at least 12 weeks to be diagnosed with CRS.

“The hope is with the consistent use of these nasal irrigations and corticosteroid sprays, we can keep symptoms at an acceptable level and so symptoms don’t affect patients’ quality of life,” Dr. Sedaghat said.

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