Nasal irrigation with or without drugs: the evidence.

To review the recent literature of nasal irrigations with or without drugs, including delivery systems, nasal saline, antibiotics, antifungals, steroids, surfactants, and interleukin (IL)-5 modulators, for the treatment of chronic rhinosinusitis (CRS). As antibiotic resistance increases in CRS, culture-directed, rather than empiric, topical antibiotics are increasingly critical in optimal treatment. Topical irrigation with mupirocin significantly reduces Staphylococcus aureus biofilm mass in vitro. Surfactants and humanized anti-IL-5 monoclonal antibody are novel therapies demonstrating promising results in CRS. Physiologic saline irrigation is beneficial in the treatment of symptoms of CRS. Low-level evidence supports the effectiveness of topical antibiotics in the treatment of CRS. The use of topical antifungals is not supported by the majority of studies. Intranasal steroids are beneficial in the treatment of CRS with nasal polyposis. There is insufficient evidence to demonstrate a clear overall benefit for topical steroids in CRS without nasal polyposis.