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

2011 ◽  
Vol 30 (1) ◽  
pp. 45-50 ◽  
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.

scholarly journals INFLUENCE OF ALLERGY ON THE IMMUNOMODULATORY AND CLINICAL EFFECTS OF LONG-TERM LOW-DOSE MACROLIDE TREATMENT OF NASAL POLYPOSIS

2010 ◽  
Vol 154 (4) ◽  
pp. 327-333 ◽  
Author(s):  
Aleksandar Peric ◽  
Danilo Vojvodic ◽  
Nenad Baletic ◽  
Aneta Peric ◽  
Olivera Miljanovic
Keyword(s):  
Nasal Polyposis ◽  
Low Dose ◽  
Clinical Effects

scholarly journals Efficacy and Safety of Long-Term Low-Dose Clarithromycin in Patients With Refractory Chronic Sinusitis After Endoscopic Sinus Surgery: A Prospective Clinical Trial

2021 ◽  
pp. 014556132110320
Author(s):  
Han Chen ◽  
Bing Zhou ◽  
Qian Huang ◽  
Cheng Li ◽  
Yubin Wu ◽  
...  
Keyword(s):  
Oral Administration ◽  
Nasal Cavity ◽  
Endoscopic Sinus Surgery ◽  
Low Dose ◽  
Continuous Treatment ◽  
Sinus Surgery ◽  
Efficacy And Safety ◽  
Endoscopic Findings ◽  
Before And After

Objective: To observe the efficacy and safety of postoperative long-term low-dose oral administration of clarithromycin in patients with refractory chronic rhinosinusitis (RCRS), to explore the characteristics of postoperative microbiota in the nasal cavity in patients with RCRS, and to compare the differences and changes in microbiota in the nasal cavity before and after medication. Methods: This was a prospective, self-controlled study. Eighteen patients with RCRS who had persistent symptoms after endoscopic sinus surgery and standard therapy with normal immunoglobulin E and eosinophil level were included. Low dose (250 mg, once daily) clarithromycin was orally administrated for 12 weeks. Symptom severity and endoscopic findings were evaluated before, after 4 weeks, and 12 weeks of treatment, and nasal cavity microbiota was analyzed simultaneously. Results: A total of 18 patients with RCRS were enrolled and 17 patients completed the study. Four weeks after oral administration of clarithromycin, significant improvement was observed in subjective symptoms including nasal congestion, rhinorrhea, postnasal drip, and general discomfort, as well as endoscopic findings including general surgical cavity condition, rhinedema, and rhinorrhea ( P < .05). After continuous treatment to the 12th week, symptoms showed significant improvement compared with baseline, and endoscopic score showed significant improvement compared with both baseline and 4 weeks after treatment. Analysis of middle nasal meatus flora revealed a significant decrease of Streptococcus pneumoniae after 12 weeks of clarithromycin treatment ( P < .05), while the richness, composition, and diversity were similar before and after treatment. Patients enrolled experienced no adverse drug reaction or allergic reaction, nor clinical significant liver function impairment observed. Conclusion: Postoperative low-dose long-term oral administration of clarithromycin in patients with RCRS can improve the clinical symptoms and facilitate the mucosal epithelialization, with good tolerance and safety. The efficacy of clarithromycin in patients with RCRS may be related to its regulatory effect on nasal cavity microbiota.

scholarly journals High and low doses of clarithromycin treatment are associated with different clinical efficacies and immunomodulatory properties in chronic rhinosinusitis

2014 ◽  
Vol 128 (3) ◽  
pp. 236-241 ◽  
Author(s):  
Y Fan ◽  
R Xu ◽  
H Hong ◽  
Q Luo ◽  
W Xia ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Clinical Efficacy ◽  
Low Dose ◽  
Symptom Assessment ◽  
Nasal Symptom ◽  
High Dose ◽  
Life Questionnaire ◽  
Short Term ◽  
Interleukin 5 ◽  
Cytokine Levels

AbstractBackground:Low-dose clarithromycin has been recommended for the treatment of chronic rhinosinusitis without nasal polyps. However, it is uncertain whether a high dose of clarithromycin is more effective than a low dose.Methods:Forty-three chronic rhinosinusitis patients were randomised to low-dose or high-dose clarithromycin groups, and clinical efficacy was evaluated. Pre- and post-treatment measures included: nasal symptom assessment, endoscopic inspection (Lund–Kennedy system), a quality of life questionnaire (the Sino-Nasal Outcome Test 20) and examination of cytokine levels (interleukin-5 and -8) in nasal secretions.Results:The high dose of clarithromycin was significantly better in terms of clinical efficacy than the low dose for the treatment of chronic rhinosinusitis (p < 0.025). Significant differences in nasal cytokine levels (interleukin-5 and -8) were also observed between the low-dose and high-dose groups after short-term clarithromycin treatment (p < 0.025).Conclusion:Short-term, high-dose clarithromycin appears to be more effective for the treatment of chronic rhinosinusitis than low-dose clarithromycin.

Long-term Low-Dose Doxycycline for Difficult-to-Treat Chronic Rhinosinusitis with Polyps

2014 ◽  
Vol 151 (1_suppl) ◽  
pp. P121-P122 ◽  
Author(s):  
Thiago Bezerra ◽  
Ana C. Soter ◽  
Rogerio Pezato ◽  
Fabio Pinna ◽  
Claus Bachert ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Low Dose

Controlled trial for long-term low-dose erythromycin after sinus surgery for chronic rhinosinusitis

2014 ◽  
Vol 125 (5) ◽  
pp. 1048-1055 ◽  
Author(s):  
Boris R. Haxel ◽  
Meike Clemens ◽  
Niki Karaiskaki ◽  
Uta Dippold ◽  
Lisanne Kettern ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Low Dose ◽  
Controlled Trial ◽  
Sinus Surgery

scholarly journals Long-term low-dose antibiotics in recalcitrant chronic rhinosinusitis: a retrospective analysis

2012 ◽  
Vol 50 (1) ◽  
pp. 45-55
Author(s):  
W.J.M. Videler ◽  
K. van Hee ◽  
S.M. Reinartz ◽  
C. Georgalas ◽  
F.W. van der Meulen ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Outpatient Clinic ◽  
Low Dose ◽  
Group Discussion ◽  
Sinus Surgery ◽  
Dose Treatment ◽  
Intranasal Corticosteroids ◽  
Significant Difference ◽  
Sinonasal Mucosa

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.

The effect of the presence of the metabolic syndrome on the efficiency narrow-band uvb ultraviolet radiation (311) in patients with psoriasis

2020 ◽  
pp. 48-56
Author(s):  
Vadim Dmitruk ◽  
Svetlana Khardikova ◽  
Marina Gerasimenko ◽  
Inna Evstigneeva ◽  
Tatiana Zaitseva
Keyword(s):  
Metabolic Syndrome ◽  
Psoriasis Vulgaris ◽  
Narrow Band ◽  
The Metabolic Syndrome ◽  
Pathological Conditions ◽  
Tnf Α ◽  
High Prevalence ◽  
Before And After ◽  
Ammatory Cytokine

Backgraund: the researchers explain the high prevalence of metabolic syndrome among patients with psoriasis by the development of systemic infl ammation, which is considered as a single pathogenetic mechanism in these pathological conditions. The response of patients with psoriasis with metabolic syndrome to treatment with narrowband therapy is currently insuffi ciently studied. Aims: the study evaluated the effi cacy of narrowband therapy (311 nm) in patients with psoriasis associated with metabolic syndrome. Materials and methods: an objective and instrumental examination was conducted in 72 patients diagnosed with psoriasis vulgaris, after which a course of 20 procedures of narrow-cavity medium-wave ultraviolet irradiation (UFO) with a wavelength of 311 nm (B) was conducted. Patients were divided into 2 groups: patients with psoriasis and patients with psoriasis combined with metabolic syndrome. To assess the eff ectiveness of treatment, the index of the area and severity of psoriasis (PASI), lipid and carbohydrate metabolism; insulin and leptin; proinfl ammatory cytokines —IL-1β, IL-8, TNF-α and anti-infl ammatory cytokine IL-10 before and after the 10th, 20th procedure of UV-B therapy and 3 and 6 months after treatment. Results: а signifi cant decrease in PASI was observed in all patients with psoriasis after 10 procedures of UV-B therapy, but in the group of patients with metabolic syndrome, the PASI index was higher. After 20 procedures, Pasi reduction by more than 50 % was observed in the group of patients with psoriasis without manifestations of metabolic syndrome (р < 0,001). Indicators of lipid and carbohydrate blood metabolism in MS patients decreased (р < 0,05), the eff ect remained up to 6 months. The level of proinfl ammatory cytokines was increased in both groups, but in the group of patients with MS these indicators were higher. In the course of therapy cytokines decreased in both groups, the eff ect was maintained up to six months. On the contrary, IL-10 was reduced in both groups, and increased after our treatment, with the prolongation of the eff ect to 6 months. Conclusions: the appointment of UV-B therapy (311 nm) in patients with psoriasis with metabolic syndrome reduces the eff ectiveness of the course in the long term, which apparently requires repeated courses of narrowband therapy after 6 months.

scholarly journals Efficacy of Medical Therapy in Treatment of Chronic Rhinosinusitis

2012 ◽  
Vol 3 (1) ◽  
pp. ar.2012.3.0027 ◽  
Author(s):  
Lee C. Young ◽  
Nicholas W. Stow ◽  
Lifeng Zhou ◽  
Richard G. Douglas
Keyword(s):  
Chronic Rhinosinusitis ◽  
Clinical Features ◽  
Medical Therapy ◽  
Oral Prednisone ◽  
Treatment Regimens ◽  
Symptom Scores ◽  
Before And After ◽  
Long Term Follow Up

Uncomplicated chronic rhinosinusitis (CRS) is generally treated with medical therapy initially and surgery is contemplated only after medical therapy has failed. However, there is considerable variation in the medical treatment regimens used and studies defining their efficacy are few. The aim of this study was to determine the proportion of patients treated medically who responded sufficiently well so that surgery was not required. Subgroup analysis to identify clinical features that predicted a favorable response to medical therapy was also performed. Eighty patients referred to the Otorhinolaryngology Clinic at North Shore Hospital were treated with a standardized medical therapy protocol (oral prednisone for 3 weeks, oral antibiotics and ongoing saline lavage and intranasal budesonide spray). Symptom scores were collected before and after medical therapy. Clinical features such as presence of polyps, asthma, and aspirin hypersensitivity were recorded. Failure of medical therapy was defined as the persistence of significant CRS symptoms, and those patients who failed medical therapy were offered surgery. Follow-up data were available for 72 (90%) patients. Of this group, 52.5%, (95% CI, 42.7%, 62.2%) failed to respond adequately to medical therapy and were offered surgery. The remaining patients (37.5%) were successfully treated with medical therapy and did not require surgery at the time of follow-up. The premedical therapy symptom scores were significantly higher than the postmedical therapy symptom scores (p < 0.01). The symptom scores of those patients postmedical therapy who proceeded to have surgery were significantly higher than the group who responded well to maximum medical therapy (MMT) and did not require surgery (p < 0.0001). There were no significant differences in the proportion of patients with asthma, aspirin sensitivity, or polyps between the groups failing or not failing MMT. In approximately one-third of patients with CRS, medical therapy improved symptoms sufficiently so that surgical therapy was avoided. Patients with more severe symptoms tended not to respond as well as those with less severe symptoms. Long-term follow-up is required for the group of responders to determine how many will eventually relapse.

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