Antibiotics following endoscopic sinus surgery. Should it be given or not?

Rhinosinusitis is defined as inflammation of the lining of the nose and paranasal sinuses. Chronic rhinosinusitis in adults is defined as presence of two or more symptoms, one of which should be either nasal obstruction or nasal discharge ± facial pain/pressure ± smell changes; for greater than or equal 12 weeks as well as endoscopic or radiological changes. Functional endoscopic sinus surgery is the mainstay of treatment of chronic rhinosinusitis after failure of proper medical treatment. In the postoperative period, surgeons usually prescribe different treatments including antibiotics. The aim of this review is to gather the researches that focused on the postoperative use of antibiotics in patients of chronic rhinosinusitis. The following MeSH terms were used to conduct the search: chronic, rhinosinusitis, endoscopy, antibiotics, postoperative. The search revealed 22 studies and 7 reviews and meta-analysis. Out of the 22 studies, 15 were randomized controlled studies, 4 prospective non-controlled study and 3 retrospective non-controlled study. Postoperative outcome was comparable in patients who received postoperative antibiotics and those who did not. Although some symptoms were better in groups receiving postoperative antibiotics, no statistically significant differences could be proved between the groups. Thus, no strong evidence could be established to make a recommendation for either to give or not to give postoperative antibiotics. This was supported by European position paper on rhinosinusitis and nasal polyps in 2020 that stated that they were unable to advise prescription of postoperative antibiotics after endoscopic sinus surgery.