10
Treatment
Table 4. Grade A/B Evidence-based Recommendations for
Medical Management of CRS
Intervention Grade Benefit Harm
CRSwNP:
Corticosteroid-
Eluting Implants
A Reduction in ethmoid
obstruction, polyp grade,
decreased need for
revision ESS, reduced
nasal obstruction scores
No findings of increased
risk of elevated
intraocular pressure or
cataracts
CRSwNP:
Dupilumab
(Biologic)
A Decreased polyp
size, improved nasal
congestion, sinus imaging
scores, sense of smell, and
asthma control
Conjunctivitis and
hyper-eosinophilia
CRSsNP:
Macrolide Antibiotics
B Reduction in endoscopy
and symptom scores
Gastrointestinal side
effects, ototoxicity,
hepatotoxicity,
cardiotoxicity, and
drug-drug interactions.
See Table 9
CRSwNP:
Macrolide Antibiotics
B May improve symptom
and endoscopic scores in
CRSwNP. Macrolides
appear to be comparable
to INCS in selected
patients
Gastrointestinal side
effects, ototoxicity,
hepatotoxicity,
cardiotoxicity, and
drug-drug interactions.
See Table 9
CRSwNP:
Non-Macrolide
Antibiotics
(<3 weeks)
B (−) Potential reduction in
polyp size with doxycycline
without change in
symptoms
GI upset, skin rash,
insomnia, and headache.
See Table 9. Potential
delay of more effective
interventions
CRSs/wNP:
Topical Antibiotics
A (−) Systematic reviews and
RCTs failed to show
benefit from the use of
topical antibiotics in CRS
Nasal congestion,
irritation, epistaxis.
eoretical possibility
of systemic absorption
aminoglycosides.
Possibility of bacterial
resistance
CRSs/wNP:
Topical Antifungals
A (−) No apparent benefit from
use of topical antifungals
Potential for local
irritation, epistaxis, and
headache less common
(cont'd)
