Abstract: Background: The nasal microbiome represents the main environmental factor of theinflammatory process in chronic rhinosinusitis (CRS). Antibiotics and steroids constitute the mainstayof CRS therapies. However, their impact on microbial communities needs to be better understood.This systematic review summarizes the evidence about antibiotics’ and steroids’ impact on thenasal microbiota in patients with CRS. Methods: The search strategy was conducted in accordancewith the PRISMA guidelines for systematic reviews. The authors searched all papers in the threemajor medical databases (PubMed, Scopus, and Cochrane Library) using the PICO tool (population,intervention, comparison, and outcomes). The search was carried out using a combination of the keyterms “Microbiota” or “Microbiome” and “Chronic Rhinosinusitis”. Results: Overall, 402 papers wereidentified, and after duplicate removal (127 papers), excluding papers off-topic (154) and for otherstructural reasons (110), papers were assessed for eligibility; finally, only 11 papers were includedand summarized in the present systematic review. Some authors used only steroids, other researchersused only antibiotics, and others used both antibiotics and steroids. With regard to the use of steroidsas exclusive medical treatment, topical mometasone and budesonide were investigated. With regardto the use of antibiotics as exclusive medical treatments, clarithromycin, doxycycline, roxithromycin,and amoxicillin clavulanate were investigated. Regarding the use of both antibiotics and steroids,two associations were investigated: systemic prednisone combined with amoxicillin clavulanate andtopical budesonide combined with azithromycin. Conclusions: The impact that therapies can haveon the nasal microbiome of CRS patients is very varied. Further studies are needed to understand therole of the nasal microbiome, prevent CRS, and improve therapeutic tools for personalized medicinetailored to the individual patient.
The impact of antibiotics and steroids on the nasal microbiome in patients with chronic rhinosinusitis: a systematic review according to PICO criteria
Carlo Cavaliere;
2023-01-01
Abstract
Abstract: Background: The nasal microbiome represents the main environmental factor of theinflammatory process in chronic rhinosinusitis (CRS). Antibiotics and steroids constitute the mainstayof CRS therapies. However, their impact on microbial communities needs to be better understood.This systematic review summarizes the evidence about antibiotics’ and steroids’ impact on thenasal microbiota in patients with CRS. Methods: The search strategy was conducted in accordancewith the PRISMA guidelines for systematic reviews. The authors searched all papers in the threemajor medical databases (PubMed, Scopus, and Cochrane Library) using the PICO tool (population,intervention, comparison, and outcomes). The search was carried out using a combination of the keyterms “Microbiota” or “Microbiome” and “Chronic Rhinosinusitis”. Results: Overall, 402 papers wereidentified, and after duplicate removal (127 papers), excluding papers off-topic (154) and for otherstructural reasons (110), papers were assessed for eligibility; finally, only 11 papers were includedand summarized in the present systematic review. Some authors used only steroids, other researchersused only antibiotics, and others used both antibiotics and steroids. With regard to the use of steroidsas exclusive medical treatment, topical mometasone and budesonide were investigated. With regardto the use of antibiotics as exclusive medical treatments, clarithromycin, doxycycline, roxithromycin,and amoxicillin clavulanate were investigated. Regarding the use of both antibiotics and steroids,two associations were investigated: systemic prednisone combined with amoxicillin clavulanate andtopical budesonide combined with azithromycin. Conclusions: The impact that therapies can haveon the nasal microbiome of CRS patients is very varied. Further studies are needed to understand therole of the nasal microbiome, prevent CRS, and improve therapeutic tools for personalized medicinetailored to the individual patient.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
