What is first-line pharmacotherapy for chronic rhinosinusitis with nasal polyps?

• A. Intranasal corticosteroids
• B. Oral antibiotics
• C. Oral corticosteroids
• D. Antihistamines

Answer: (B)

First-line pharmacotherapy for chronic rhinosinusitis with nasal polyps is intranasal corticosteroids. Delivering the medication directly to the nasal mucosa, these sprays reduce mucosal inflammation, shrink polyp size over time, and improve nasal obstruction and sense of smell with a favorable safety profile for long-term use. They address the underlying inflammatory process rather than just symptoms, which is why they form the foundation of management.

Oral antibiotics are not used initially for this condition unless there’s a clear acute bacterial infection; they don’t reliably reduce polyp burden in chronic cases. Oral corticosteroids can rapidly improve symptoms and shrink polyps, but their benefits are temporary and they carry more systemic risks, so they’re reserved for short courses or severe flares rather than long-term management. Antihistamines may help if there’s an allergic component, but they don’t treat the polyps themselves as effectively as topical anti-inflammatory therapy.