Treatment of chronic rhinosinusitis and acute recurring rhinosinusitis with omadacycline: A case series.

Chronic rhinosinusitis (CRS), defined as persistent inflammation of the sinuses lasting longer than 12 weeks, and recurrent acute rhinosinusitis (RARS), characterized by multiple distinct episodes of acute bacterial sinusitis within a year, are among the most common chronic illnesses in the US. Several risk factors, including gastroesophageal reflux disease (GERD) are associated with CRS and RARS. For exacerbations of CRS and recurrent episodes of RARS, antibiotic therapy is the mainstay of treatment; however, a significant subpopulation of patients remain resistant to treatment, despite rigorous and prolonged treatment. Consequently, patients experience frequent recurrences and more complex infections involving multiple organisms. Multidrug resistant bacterial strains, such as methicillin-resistant Staphylococcus aureus (MRSA), are increasingly implicated in treatment failure. Thus, there is a need for new therapies to treat patients with CRS and RARS effectively. Omadacycline is a tetracycline derivative antibiotic approved by the FDA to treat adult patients with community-acquired bacterial pneumonia and acute skin and skin structure infections. Omadacycline has broad spectrum activity against select pathogens and was proven to be effective against select multidrug resistant bacteria, including MRSA. Presented here are three cases of patients with underlying GERD and polymicrobial chronic sinusitis involving MRSA, along with several gram-negative enteric organisms, who were successfully treated with omadacycline after many years of recurrent infections. Omadacycline was shown to be an oral option for patients with infectious exacerbations of CRS and RARS involving antibiotic resistance and was well tolerated. These findings suggest that further investigation of omadacycline in this setting is warranted.