Topical antimicrobials delivered by nasal spray. There was no evidence in two double blind RCTs (n=128) for the delivery of antimicrobials by nasal spray in patients with stable CRS.
Topical antimicrobials delivered by nasal irrigation: one small (n=30) RCT found statistically significant improvements in mucosal thickening and intranasal inflammatory markers in patients who received Amphotericin compared to those who received placebo. The patients in this trial had stable CRS with previous surgery. Another RCT found no differences in any outcome measure between the treatment and placebo groups. An additional five studies (four single-arm cohort studies and one clinical experience report) showed positive outcomes with treatment by nasal irrigation. Most of the patients had stable CRS, although some had previous surgery and some experienced acute exacerbations in their condition.
Nebulised antimicrobials: one small double-blind RCT (n=20) showed statistically significant improvements from baseline for both treatment (with Tobramycin) and control groups (saline only) in endoscopic findings, quality of life and symptom severity. There were no differences in outcomes at follow-up observed between the Tobramycin and saline groups. In the remaining cohort studies and one multiple-arm controlled study, benefits were observed from treatment with nasal microbials in endoscopy findings, symptoms and quality of life scores for the groups receiving antimicrobials.
Post-functional endoscopic sinus surgery patients: eight studies (n=330). Two RCTs (n=71) showed no benefit of treatment. In the smaller RCT (n=20) there was no significant difference between treatment and control groups, although both groups showed statistically significant improvements on all outcomes examined. The remaining six studies on this subset of patients were cohort studies. All of these studies showed a beneficial effect for both irrigated and nebulised antimicrobials.
Empiric therapy: 10 studies presented empiric (nonculture-directed) therapy. Of the six studies that showed efficacy with antimicrobial treatment, only one was a small RCT (n=30).
Acute exacerbations of CRS: one multiple-arm controlled study (n=42) showed some benefit in the outcome of longer infection-free periods. A small cohort study found some benefit of nasal irrigation with antimicrobials in symptomatic improvement clinical and endoscopic findings.