Is greater antibiotic therapy prior to ESS associated with differences in surgical outcomes in CRS?

Vijay R. Ramakrishnan, Jess C. Mace, Zachary M. Soler, Timothy L. Smith

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objective: Antibiotics have been a mainstay of chronic rhinosinusitis therapy; however, data suggest that antibiotics may also result in several adverse unintended consequences. We aimed to evaluate if greater antibiotic use prior to sinus surgery was associated with differences in surgical outcomes. Methods: Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study were asked to recall systemic antibiotic use in the 90 days prior to endoscopic sinus surgery (ESS). Antibiotic use was examined in relation to demographics, disease characteristics, and outcomes. Results: Data were collected for 271 study participants followed for a mean of 14.9 [± 5.1] months across four institutions, with a mean preoperative antibiotic use of 27.8 [± 22.7] days out of the 90 preceding ESS. After ESS, significant improvement (P < 0.001) was reported for patient-reported outcome measures and endoscopy scores for the overall cohort. No bivariate correlation between preoperative antibiotic use and degree of benefit in objective clinical measures (endoscopy, Brief Smell Identification Test) was seen. Increased preoperative antibiotic use was associated with less improvement in 22-item SinoNasal Outcome Test (SNOT-22) and its rhinologic subdomain after ESS. Prevalence of achieving a minimal clinically important difference in overall SNOT-22 symptom scores was lower in those using more preoperative antibiotics, although statistical significance was not reached when adjusting for independent covariates in multivariate modeling. Conclusion: Higher amounts of previous antibiotic use do not appear to be associated with better ESS outcomes. Specific recommendations for antibiotic use as part of CRS-appropriate medical therapy prior to ESS require further study, particularly given concerns for antibiotic overuse and implications for improving outcomes in the modern healthcare era. Level of Evidence: 2C Laryngoscope, 129:558–566, 2019.

Original languageEnglish (US)
Pages (from-to)558-566
Number of pages9
Issue number3
StatePublished - Mar 2019


  • Sinusitis
  • antibacterial
  • endoscopy
  • multicenter study
  • outcome assessment (healthcare)
  • prospective studies
  • sinus surgery

ASJC Scopus subject areas

  • Otorhinolaryngology


Dive into the research topics of 'Is greater antibiotic therapy prior to ESS associated with differences in surgical outcomes in CRS?'. Together they form a unique fingerprint.

Cite this