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Culture-inappropriate antibiotic therapy decreases quality of life improvement after sinus surgery.
- Source :
-
International forum of allergy & rhinology [Int Forum Allergy Rhinol] 2014 May; Vol. 4 (5), pp. 403-10. Date of Electronic Publication: 2014 Jan 10. - Publication Year :
- 2014
-
Abstract
- Background: Despite their widespread use, antibiotics have not been shown to improve chronic rhinosinusitis (CRS) outcomes. We aimed to determine whether culture-inappropriate postoperative antibiotic therapy was associated with less quality-of-life (QOL) improvement following functional endoscopic sinus surgery (FESS).<br />Methods: This retrospective cohort study recruited 376 adult CRS patients undergoing FESS between October 1, 2007 to December 31, 2011. Patient demographics, comorbidities and medications were collected at baseline. Trimethoprim-sulfamethoxazole and clindamycin were administered for 2 weeks postoperatively. The antibiotic appropriateness was determined based on bacterial resistance profile of organisms identified during intraoperative culture. The QOL outcome was defined as change of 22-item Sinonasal Outcome Test scores from preoperative visit to 1-month, 3-month, and 6-month post-FESS. Clinically significant difference was defined as at least 0.5 standard deviations (SD) of baseline QOL score in the reference group. Mixed-effects regression models were performed.<br />Results: Seven percent of patients (n = 27) had culture-inappropriate antibiotic therapy, and additional 5% (n = 19) had culture-specific antibiotic adjustment. Compared to patients with culture-appropriate antibiotics, patients with culture-inappropriate antibiotics had significantly less improvement of QOL from baseline to postoperative 1-month and 3-month follow-up where the difference became clinically significant; patients with antibiotic adjustment had more QOL improvement from baseline to 1-month follow-up, but their QOL worsened at 3-month follow-up, and these changes were not clinically significant. However, all effects washed out at 6-month follow-up with no significant differences.<br />Conclusion: Culture-inappropriate postoperative antibiotic therapy decreased short-term QOL improvement to a clinically meaningful level after FESS. Culture guided selection of antibiotics may improve short-term FESS outcome.<br /> (© 2014 ARS-AAOA, LLC.)
- Subjects :
- Adult
Chronic Disease
Clindamycin administration & dosage
Clindamycin adverse effects
Cohort Studies
Drug Resistance, Bacterial
Female
Follow-Up Studies
Humans
Male
Middle Aged
Paranasal Sinuses surgery
Postoperative Period
Quality of Life
Retrospective Studies
Treatment Outcome
Trimethoprim, Sulfamethoxazole Drug Combination administration & dosage
Trimethoprim, Sulfamethoxazole Drug Combination adverse effects
Antibiotic Prophylaxis adverse effects
Endoscopy
Paranasal Sinuses drug effects
Rhinitis therapy
Sinusitis therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2042-6984
- Volume :
- 4
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- International forum of allergy & rhinology
- Publication Type :
- Academic Journal
- Accession number :
- 24415647
- Full Text :
- https://doi.org/10.1002/alr.21277