When a Sinus Culture Changes the Treatment
Look below and you’ll see my latest blog post about the growing threat of antibiotic resistance. ENTs are notorious for prescribing antibiotics as a prophylactic measure, before the results of a culture are known.
Yet experts agree that this sort of preventive prescription can sometimes do more harm than good, encouraging the rise of superbugs while offering minimal advantage to the patient.
A recent study demonstrated just how different these choices become when a definitive culture is available to the prescribing doctor:
Culture results changed antibiotic choices in 77% of patients. Statistically significant change in total SNOT-20 scores and all 4 subdomains was noted, with improvement being clinically meaningful in the rhinologic subdomain (-1.10, p<0.0001). Repeat purulence was only noted in 5 cases (4.8%). Multivariate regression analysis demonstrated that concurrent use of oral steroids was independently associated with improvement in the rhinologic subdomain (p=0.0041). The mean length of follow-up was 37 days. Length of follow-up (14-30, 31-60, 61-90 days) did not statistically impact SNOT-20 scores.
In English: fully 77% of antibiotic prescription choices a culture was taken. This is a high number that should give all otolaryngologists pause, and is one of the principal reasons why I perform endoscopically guided cultures on all my patients before issuing any antibiotics.