A 35-year-old male with chronic rhinosinusitis with nasal polyps (CRSwNP) fails 3 months of topical steroids and saline irrigation. Which additional pharmacological agent has the strongest level of evidence for reducing polyp size and delaying recurrence?

• A Oral montelukast
• B A short course of systemic corticosteroids (oral prednisolone) ✓
• C Long-term low-dose macrolide (azithromycin)
• D Intranasal ipratropium

Explanation

Short courses of systemic corticosteroids (oral prednisolone 0.5 mg/kg/day for 1–2 weeks) are the most evidence-based pharmacological intervention for reducing polyp size in CRSwNP that has failed topical steroids. They provide significant short-term reduction in polyp mass and symptom improvement. Macrolides benefit CRSsNP with predominantly neutrophilic inflammation, not polyp reduction. Montelukast and ipratropium have insufficient evidence for polyp size reduction.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.