Current and emerging treatment modalities for bacterial rhinosinusitis in adults: a comprehensive review

ABSTRACT

Introduction

Rhinosinusitis (RS) is defined as acute when it lasts up to 4 weeks and chronic when it lasts at least 12 weeks. Most acute forms begin with a viral upper respiratory infection that spreads into the paranasal sinuses and is followed by bacterial infection. It is uncertain how bacteria affect chronic rhinosinusitis (CRS).

Area covered

We review the current treatment of bacterial rhinosinusitis in adults, referring mainly to the two key documents published by the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 and the International Consensus Statement 2021 on Allergy and Rhinology: Rhinosinusitis.

Expert opinion

The routine use of antibiotics should be avoided because most acute RS (ARS) have a viral origin. In patients with persistent/worsening symptoms, the most appropriate empirical therapy is a course of amoxicillin (with or without clavulanate). Macrolides are considered therapy options for CRS mainly because of their anti-inflammatory activity. The best agent, dose, and treatment duration still need to be identified due to a lack of solid evidence. Inflammation and symptoms must also be reduced, mainly by using nasal corticosteroids. Since antibiotic use in bacterial rhinosinusitis is questionable, the research focuses on non-antibiotic antimicrobial treatments.

KEYWORDS:

• Acute bacterial rhinosinusitis
• chronic rhinosinusitis
• Nasal Polyps
• antibiotics
• corticosteroids
• nonantibiotic antimicrobial therapies
• bacteriophages
• probiotics

Article highlights

• Rhinosinusitis is an inflammation of the nasal cavity and paranasal sinuses. It is defined as acute when it lasts up to 4 weeks and chronic when it lasts at least 12 consecutive weeks.

• Most acute forms begin with a viral upper respiratory infection that spreads into the paranasal sinuses and is followed by bacterial infection. It is still uncertain how bacteria affect CRS.

• The two recently published key documents, the EPOS 2020 and the ICAR-RS-2021, provide the most up-to-date evidence on how to treat the various forms of rhinosinusitis, including those sustained by bacteria.

• Despite evidence that antibiotics may reduce the duration of bacterial rhinosinusitis, their comparative effectiveness over placebo remains minimal. However, the most appropriate therapy is a course of amoxicillin (with or without clavulanate). Still, recommendations for antibiotics in CRS are considered options, given the conflicting or missing evidence in the current literature.

• In the presence of bacterial rhinosinusitis, there is also a need to reduce the inflammatory status and treat the symptoms. Nasal corticosteroids appear useful mainly for CRS.

• Due to the controversial role of antibiotics in bacterial rhinosinusitis, research attention is shifting to using non-antibiotic antimicrobial therapies.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.