Should topical antibiotics be routinely used following sinus surgery?

BACKGROUND The role of bacterial infections in the etiology of stable chronic rhinosinusitis (CRS) is unclear. The advantages of nasal saline irrigation following endoscopic sinus surgery (ESS) are well documented. Nasal irrigation is also superior to nebulizers and sprays. Adding topical antibiotics to saline irrigation theoretically confers the additional advantages of direct delivery of antibiotics in high concentrations to the diseased mucosa with a low risk of systemic adverse effect. In addition, ESS provides abundant sinus mucosal access and allows increased distribution of the topical antibiotic, improved aeration of the sinuses, and return of normal mucociliary clearance function.