Add-on effect of clarithromycin to oral steroids as post- operative therapy for chronic rhinosinusitis with nasal polyps: a randomised controlled trial

Cf, Lin; Mc, Wang; Merton, A T; Ho, N-H; Wu, P-S; Hsu, A T-W; Yp, Wang

doi:10.4193/rhin19.325

Cited by 12 publications

(27 citation statements)

References 44 publications

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“…23 In another double-blind, randomized, placebo-controlled study, Lin found that adding low-dose clarithromycin to oral corticosteroids as a post-ESS therapy showed beneficial subjective and objective outcomes in patients with chronic rhinosinusitis with nasal polyposis, especially those without tissue eosinophilia. 24 That’s the reason our study selected the patients with nonatopic, noneosinophilic RCRS with normal serum IgE. However, although this association was found, other studies reported discordant results.…”

Section: Discussionmentioning

confidence: 80%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 80%

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

et al. 2021

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“…In a double-blind placebo-controlled RCT with 126 patients, the addition of 12 weeks of oral clarithromycin to 2 weeks of oral corticosteroids as post-operative therapy resulted in reduced SNOT-22 and improved endoscopy scores, especially in patients without tissue eosinophilia (180) . These results could not be found in 187 postoperative CRS patients randomized to receive either intranasal fluticasone proprionate or daily clarithromycin for 12 weeks, regardless of polyp or eosinophilia status (181) .…”

Section: Surgery and Post-operative Care In Crsmentioning

confidence: 98%

Rhinology in review: from COVID-19 to biologicals

Fokkens¹,

Landis²,

Hopkins³

et al. 2021

Rhin

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We look back at the end of what soon will be seen as an historic year, from COVID-19 to real-world introduction of biologicals influencing the life of our patients. This review describes the important findings in Rhinology over the past year. A large body of evidence now demonstrates loss of sense of smell to be one of the most common symptoms of COVID-19 infection; a meta-analysis of 3563 patients found the mean prevalence of self-reported loss to be 47%. A number of studies have now shown long-term reduced loss of smell and parosmia. Given the high numbers of people affected by COVID-19, even with the best reported recovery rates, a significant number worldwide will be left with severe olfactory dysfunction. The most prevalent causes for olfactory dysfunction, besides COVID-19 and upper respiratory tract infections in general, are trauma and CRSwNP. For these CRSwNP patients a bright future seems to be starting with the development of treatment with biologics. This year the Nobel prize in Medicine 2021 was awarded jointly to David Julius and Ardem Patapoutian for their discoveries of receptors for temperature and touch which has greatly enhanced our understanding of nasal hyperreactivity and understanding of intranasal trigeminal function. Finally, a new definition of chronic rhinitis has been proposed in the last year and we have seen many papers emphasizing the importance of endotyping patients in chronic rhinitis and rhinosinusitis in order to optimise treatment effect.

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“…34 Nevertheless, there were some differences in the specific kind of macrolide and methods used in the studies. Clarithromycin was used in 4 studies, [25][26][27]34 erythromycin was used in 2 studies, 20,21 and azithromycin was used in 2 studies. 24,35 However, all studies used oral, long-term, and low-dose administration of macrolide.…”

Section: Basic Characteristics Of the Included Studiesmentioning

confidence: 99%

Systematic Review and Meta‐analysis: Macrolide in the Treatment of Chronic Rhinosinusitis After Endoscopic Sinus Surgery

Shu,

Li,

Zhang

et al. 2023

Otolaryngol.--head neck surg.

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ObjectivesTo evaluate the efficacy and safety of macrolide antibiotics therapy in patients with chronic rhinosinusitis (CRS) receiving endoscopic sinus surgery.Data SourcesPubMed, Web of Science, Embase, and Cochrane Library.Review MethodsThe electronic databases were comprehensively searched on June 2, 2022, for randomized controlled trials on macrolide antibiotics in the treatment of patients undergoing CRS endoscopic surgery. The primary outcome measures were the sinonasal outcome test (SNOT) score and the visual analog scale (VAS) score. The secondary outcome measures were the nasal endoscopy score (NES), the sinus computed tomography score, and adverse events.ResultsA total of 8 studies were included, involving 606 patients who used macrolide for a long time. Meta‐analysis showed that no significant difference was observed in SNOT (standardized mean difference [SMD] = −0.13; 95% confidence interval [CI]: −0.38 to 0.13, I2 = 0%) and VAS (SMD = −0.10; 95% CI, −0.88 to 0.68, I2 = 81%) between the macrolide and placebo groups. However, macrolide outperformed the placebo in improving NES (SMD = −0.32; 95% CI, −0.62 to −0.03, I2 = 21%). The use of macrolide did not increase the incidence of adverse events.ConclusionLong‐term use of macrolide after CRS surgery may not significantly improve the quality of life and disease severity of the patients but may play a role in improving postoperative NES in patients with CRS. There is still no sufficient evidence to determine whether the disease phenotype of CRS or the patient's race will affect the efficacy of long‐term use of macrolide after CRS.

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Add-on effect of clarithromycin to oral steroids as post- operative therapy for chronic rhinosinusitis with nasal polyps: a randomised controlled trial

Cited by 12 publications

References 44 publications

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

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

Rhinology in review: from COVID-19 to biologicals

Systematic Review and Meta‐analysis: Macrolide in the Treatment of Chronic Rhinosinusitis After Endoscopic Sinus Surgery

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