Postoperative doxycycline after endoscopic sinus surgery for chronic rhinosinusitis: systematic review with quantitative synthesis
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20254100Keywords:
Chronic rhinosinusitis, Endoscopic, Doxycycline, Antibiotics, Randomized trialsAbstract
The antibiotics are commonly and frequently prescribed after endoscopic sinus surgery to treat chronic sinusitis, although their clinical benefit remains uncertain. One such antibiotic, doxycycline, has antimicrobial and anti-inflammatory properties, which improve postoperative recovery. However, recent reviews of infectious complications after endoscopic sinus surgery suggest the importance of antibiotic use, but routine postoperative antibiotic use remains controversial. The study aims to assess whether postoperative systemic doxycycline improves symptoms, endoscopic healing, complications, or microbiome recovery after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). A PRISMA 2020-oriented systematic review with quantitative synthesis was conducted. The randomized or quasi-randomized adult studies comparing postoperative doxycycline versus placebo/standard care. The searches were performed in MEDLINE (PubMed), Embase, CENTRAL, and Scopus. The results show that of the 247 records screened, two randomized, double-blind, controlled trials met the inclusion criteria. Both evaluated doxycycline (100 mg for 28 days versus placebo) compared to placebo after esophagoscopy in adults with chronic atrophic rhinitis (with or without nasal polyps). Endoscopy and microbiome findings showed no sustained benefit with doxycycline. Side effects were rare and similar between groups. The certainty of the evidence ranged from low to moderate for all outcomes. The authors concluded that the current randomized evidence does not support a symptomatic or endoscopic advantage of postoperative doxycycline after ESS for CRS. While generally safe, its routine use cannot be justified given low-certainty evidence and the importance of antibiotic stewardship. Larger, well-powered trials with standardized outcomes are needed to clarify its role.
Metrics
References
Bice AA, Wyatt TH. Holistic comfort interventions for pediatric nursing procedures: a systematic review. J Holist Nurs. 2017;35(3):280-95. DOI: https://doi.org/10.1177/0898010116660397
Chorath K, Hobday S, Suresh NV, Go B, Moreira A, Rajasekaran K. Enhanced recovery after surgery protocols for outpatient operations in otolaryngology: review of literature. World J Otorhinolaryngol Head Neck Surg. 2022;8(2):96-106. DOI: https://doi.org/10.1002/wjo2.58
Rădeanu DG, Bronescu V, Stan C, Palade OD, Maniu AA. Chronic rhinosinusitis: a multifaceted burden on patients and society—a systematic review. Surgeries. 2025;6(3):48. DOI: https://doi.org/10.3390/surgeries6030048
Tănase MI, Tanase M, Cosgarea M, Radeanu GD, Pop SS, Maniu AA. Biologic treatments for chronic rhinosinusitis with nasal polyps (CRSwNP): a comparative review of efficiency and risks. Cureus. 2025;17(1). DOI: https://doi.org/10.7759/cureus.77804
Chen S, Zhou A, Emmanuel B, Thomas K, Guiang H. Systematic literature review of the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyposis. Curr Med Res Opin. 2020;36(11):1897-911. DOI: https://doi.org/10.1080/03007995.2020.1815682
Stevens WW, Schleimer RP, Kern RC. Chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol Pract. 2016;4(4):565-72. DOI: https://doi.org/10.1016/j.jaip.2016.04.012
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. EPOS: European position paper on rhinosinusitis and nasal polyps. 2020;58(29):1-464. DOI: https://doi.org/10.4193/Rhin20.601
Rudmik L, Soler ZM. Medical therapies for adult chronic sinusitis: a systematic review. JAMA. 2015;314(9):926-39. DOI: https://doi.org/10.1001/jama.2015.7544
Fokkens WJ, Viskens AS, Backer V, Conti D, De Corso E, Gevaert P, et al. EPOS/EUFOREA update on indication and evaluation of biologics in chronic rhinosinusitis with nasal polyps 2023. Rhinology. 2023;61(3):194-202. DOI: https://doi.org/10.4193/Rhin22.489
Cho DY, Hunter RC, Ramakrishnan VR. The microbiome and chronic rhinosinusitis. Immunol Allergy Clin North Am. 2020;40(2):251-67. DOI: https://doi.org/10.1016/j.iac.2019.12.009
Cope EK, Goldberg AN, Pletcher SD, Lynch SV. Compositionally and functionally distinct sinus microbiota in chronic rhinosinusitis patients have immunological and clinically divergent consequences. Microbiome. 2017;5(1):53. DOI: https://doi.org/10.1186/s40168-017-0266-6
Tai J, Han MS, Kwak J, Kim TH. Association between microbiota and nasal mucosal diseases in terms of immunity. Int J Mol Sci. 2021;22(9):4744. DOI: https://doi.org/10.3390/ijms22094744
Shi N, Li N, Duan X, Niu H. Interaction between the gut microbiome and mucosal immune system. Mil Med Res. 2017;4(1):14. DOI: https://doi.org/10.1186/s40779-017-0122-9
Paulo AC, Lança J, Almeida ST, Hilty M, Sá-Leão R. The upper respiratory tract microbiota of healthy adults is affected by Streptococcus pneumoniae carriage, smoking habits, and contact with children. Microbiome. 2023;11(1):199. DOI: https://doi.org/10.1186/s40168-023-01640-9
O'Shaughnessy J, Chiu J, Shim T, Liao Y, Yang J, Chung S, et al. Incidence and risk factors for toxic shock syndrome after endoscopic sinus surgery: a systematic review. Otolaryngol Head Neck Surg. 2025;172(2):399-405. DOI: https://doi.org/10.1002/ohn.1010
Van Zele T, Gevaert P, Holtappels G, Beule A, Wormald PJ, Mayr S, et al. Oral steroids and doxycycline: two different approaches to treat nasal polyps. J Allergy Clin Immunol. 2010;125(5):1069-76. DOI: https://doi.org/10.1016/j.jaci.2010.02.020
Huvenne W, Zhang N, Tijsma E, Hissong B, Huurdeman J, Holtappels G, et al. Pilot study using doxycycline‐releasing stents to ameliorate postoperative healing quality after sinus surgery. Wound Repair Regen. 2008;16(6):757-67. DOI: https://doi.org/10.1111/j.1524-475X.2008.00429.x
Chan D, Ooi E, Khalid O. A systematic review and meta-analysis of the role of doxycycline in chronic rhinosinusitis. J Laryngol Otol. 2023;137(5):474-83. DOI: https://doi.org/10.1017/S0022215122001803
Kim DH, Shin H, Stybayeva G, Hwang SH. A comparison of doxycycline and conventional treatments of refractory chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2024;281(8):3949-57. DOI: https://doi.org/10.1007/s00405-024-08563-7
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. DOI: https://doi.org/10.1136/bmj.n71
Challis JM, Baptista MS, Ragupathy R, Lee CKW, Wood AJ. A pilot randomised controlled trial of oral doxycycline after endoscopic sinus surgery and its effects on the sinonasal microbiome. 2022;5:49-61. DOI: https://doi.org/10.4193/RHINOL/22.004
De Schryver E. Influence of oral doxycycline on wound healing after functional endoscopic sinus surgery. Ghent (Belgium): Ghent University. 2019.
Swords CE, Wong JJ, Stevens KN, Psaltis AJ, Wormald PJ, Tan NCW. The use of postoperative antibiotics following endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta-analysis. Am J Rhinol Allergy. 2021;35(5):700-12. DOI: https://doi.org/10.1177/1945892421989142
Parasher AK, Kidwai SM, Konuthula N, Goljo E, Pan S, Saini AT, et al. The role of doxycycline in the management of chronic rhinosinusitis with nasal polyps. Am J Otolaryngol. 2019;40(4):467-72. DOI: https://doi.org/10.1016/j.amjoto.2019.03.004
Nabavi M, Arshi S, Bemanian MH, Fallahpour M, Shokri S, Sabouri S, et al. Doxycycline improves quality of life and anosmia in chronic rhinosinusitis with nasal polyposis: a randomized controlled trial. Am J Rhinol Allergy. 2023;37(4):384-90. DOI: https://doi.org/10.1177/19458924231154066
Downloads
Published
How to Cite
Issue
Section
