Prognostic Factors of Chronic Rhinosinusitis under Long-Term Low-Dose Macrolide Therapy

Introduction: In recalcitrant Chronic RhinoSinusitis (CRS) treatment with intranasal corticosteroids, short-term antibiotics and even sinus surgery is frequently insufficient. Long-term low-dose administration of antibiotics has been suggested as a treatment option in these patients. We analysed the outpatient clinic population treated with different long-term low-dose antibiotics at the AMC Amsterdam. Patients and methods: Eligible patients, who were treated with trimethoprim-sulfamethoxazole or macrolides, were retrospectively identified from our outpatient clinic in 2009. The two main outcome measures were sinonasal complaints and nasal endoscopic findings. A 5-point grading scale was used to score the results compared with the pre-treatment situation. This was measured at several time-points during, and after the antibiotic course, and at the end of the follow-up term. Results: Seventy-six patients were included, 53 per cent had asthma and all of them had undergone sinus surgery. Seventy-eight per cent showed improvement of the symptoms, and 84 per cent demonstrated improvement of the sinonasal mucosa at the end of the course. No significant difference was found between the trimethoprim-sulfamethoxazole and macrolide group. Discussion: Long-term low-dose treatment with antibiotics seems to improve CRS symptoms and the appearance of the sinonasal mucosa on nasal endoscopy. However, at this stage, strong conclusions are immature because no placebo-group has been included. Despite increasing use of long-term low-dose treatment of recalcitrant CRS in referral centres, hard clinical evidence is lacking. More research is urgently required.

Download Full-text

Faculty Opinions recommendation of Lack of efficacy of long-term, low-dose azithromycin in chronic rhinosinusitis: a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13408963.14779068 ◽

2011 ◽

Author(s):

Erik K Weitzel ◽

Matthew Connor

Keyword(s):

Randomized Controlled Trial ◽

Chronic Rhinosinusitis ◽

Low Dose ◽

Controlled Trial ◽

Randomized Controlled

Download Full-text

Trimethoprim/Sulfamethoxazol bei Rhinosinusitis – erste vorläufige Resultate

Laryngo-Rhino-Otologie ◽

10.1055/a-0677-5393 ◽

2018 ◽

Vol 97 (12) ◽

pp. 832-833

Author(s):

Boris Haxel

Keyword(s):

Prospective Study ◽

Functional Outcome ◽

Chronic Rhinosinusitis ◽

Low Dose ◽

A Prospective Study

de Bonnecaze G et al. Functional outcome after long-term low-dose trimethoprim/sulfamethoxazole in chronic rhinosinusitis with purulence: a prospective study. J Laryngol Otol 2018; 132: 600–604 Trimethoprim/Sulfamethoxazol gilt als eine alternative Behandlungsoption der chronischen Rhinosinusitis. In einer prospektiven Studie wurden funktionelle und endoskopische Ergebnisse nach einer dreimonatigen Behandlung mit der niedrig dosierten Antibiotika-Kombination dokumentiert.

Download Full-text

Immunomodulatory and Clinical Effects of Long-Term Low-Dose Macrolide Treatment of Chronic Rhinosinusitis with Nasal Polyposis

Journal of Medical Biochemistry ◽

10.2478/v10011-010-0043-6 ◽

2011 ◽

Vol 30 (1) ◽

pp. 45-50 ◽

Cited By ~ 1

Author(s):

Aleksandar Perić ◽

Danilo Vojvodić ◽

Nenad Baletić ◽

Aneta Perić ◽

Olivera Miljanović

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Polyposis ◽

Low Dose ◽

Nasal Symptom ◽

Clinical Effects ◽

Flow Cytometric Method ◽

Tnf Α ◽

Before And After ◽

Nasal Fluid

Immunomodulatory and Clinical Effects of Long-Term Low-Dose Macrolide Treatment of Chronic Rhinosinusitis with Nasal PolyposisImmunomodulatory treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP) by macrolide antibiotics represents a challenging alternative to conventional therapy and surgery, still being at the very beginning. Immune and inflammatory processes in nasal and paranasal sinus mucosa, crucial in the etiopathogenesis of nasal polyps (NPs) are reflected in levels of various local mediators, found both in mucosa and nasal fluid. In this prospective study, we assessed the immunomodulatory and clinical effects of longterm low-dose oral macrolide treatment in the management of CRSwNP. Twenty-two (n = 22) nonasthmatic, nonallergic patients with CRSwNP were administered clarithromycin (CAM) 500 mg/day single oral dose for eight weeks. We measured the levels of proinflammatory cytokines TNF-α, TNF-β, and IL-1β, Th1 cytokines IL-2, IL-12, and IFN-γ, Th2 cytokines IL-4, IL-5, IL-6, and IL-10, and chemokine IL-8 in the nasal fluid samples, before and after treatment, using a flow cytometric method. We also scored each of the 22 patients before and after therapy according to Tsicopoulos' global nasal symptom score and Malm's endoscopic score. Following treatment, we found significantly reduced levels of IL-8 (p<0.01) and TNF-α (p<0.01) in nasal secretions. Macrolide therapy decreased the size of polyps in 45.45% of the patients. We concluded that long-term low-dose treatment with CAM was effective in the management of CRSwNP. We suggest that macrolides can be an alternative to topical and systemic corticosteroids in the management of CRSwNP.

Download Full-text