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Letters to the Editor
May 2000

Antimicrobial Treatment and Recurrent Rhinosinusitis

Arch Otolaryngol Head Neck Surg. 2000;126(5):690. doi:10.1001/archotol.126.5.690

In the interesting retrospective study by Drs Bhattacharyya and Kepnes,1 which appeared in the October 1999 issue of the ARCHIVES, antimicrobial therapy was considered a key element in the management of recurrent rhinosinusitis after endoscopic sinus surgery. Also, they refer to culture results for antimicrobial adjustment.

I am not sure, however, how valuable the results of culture could be in an area in which multiple growth is common and in which the results of in vitro studies could contrast with those of in vivo studies. Besides, unless the primary underlying condition is addressed first, and/or unless one is treating an unusual immunedeficiency presentation, it is not appropriate to prescribe antibiotherapy, even in cases in which the results of culture are positive.The majority of unsatisfactory results in cases involving endoscopic sinus surgery are attributable to premature surgical procedures. Many of the patients have multiple underlying disorders, and anatomical modification, even with the most sophisticated surgical techniques, cannot improve them.

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