Managing chronic sinusitis: Is 3 weeks of antibiotics enough?

In the treatment of chronic rhinosinusitis, antibiotics are often given for 3 to 6 weeks, but the optimal regimen has not been established. Dubin and coworkers conducted a study to assess the effectiveness of a 3-week course. They found that for some patients, significant radiographic improvement occurs when antibiotics are given for more than 3 weeks.

Their study included 35 patients who had documented chronic rhinosinusitis without polyposis. Antibiotics were prescribed for all patients for 6 weeks. When possible, culture-directed antibiotics were given; otherwise, empiric therapy with clindamycin was given. CT scans were obtained at baseline and after 3 and 6 weeks of therapy. A total of 16 patients received antibiotics for 6 weeks and underwent all 3 CT scans.

In 6 patients (38%), CT results significantly improved between weeks 3 and 6. In these patients, 37% of the overall CT improvement occurred during that interval. The study did not identify any variables that predicted which patients would have additional improvement in CT findings.

The authors conclude that to achieve the best outcomes in patients with chronic rhinosinusitis, it may be necessary to give antibiotics for more than 3 weeks.