Medical management of pediatric chronic rhinosinusitis

As a first-line medical treatment, standard management includes intranasal corticosteroids and saline irrigation. Short-course antibiotics or systemic corticosteroids are prescribed only when clearly indicated and limited to selected cases. Target therapies as monoclonal antibodies, are considered salvage options for children who do not respond adequately to standard medical or surgical treatments. Dupilumab and tezepelumab are currently the only biologics approved for adolescents with CRS, while other monoclonal antibodies are still under consideration in pediatric CRS. Regulatory approvals are largely based on results extrapolated from adults or from clinical studies conducted in other respiratory diseases. Data on the efficacy and safety of novel therapies are still limited, because pediatric-specific randomized clinical trials are limited. Future studies should focus on the early identification of comorbidities, the development of personalized treatment strategies, and improved safety.