Lack of efficacy of long‐term, low‐dose azithromycin in chronic rhinosinusitis: a randomized controlled trial

Videler, W J M; Badia, Lydia; Harvey, Richard J.; Gane, Simon; Georgalas, Christos; Meulen, Freerk W. van der; Menger, Dirk Jan; Lehtonen, Mikko; Toppila‐Salmi, Sanna; Vento, Seija; Hytönen, Maija; Hellings, Peter W.; Kalogjera, Livije; Lund, Valerie J.; Scadding, Glenis; Mullol, Joaquim; Fokkens, Wytske J.

doi:10.1111/j.1398-9995.2011.02693.x

Cited by 176 publications

(184 citation statements)

References 37 publications

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“…However, a recent study including 60 patients with recalcitrant CRS (with and without nasal polyps) unresponsive to optimal medical or surgical treatment, reported no significant differences in symptom scores or objective measures after a 3-month course of azithromycin compared with placebo [95], highlighting the need for matching patient characteristics, drug-administered and outcome measures before comparing the results of different studies.…”

Section: Chronic Rhinosinusitismentioning

confidence: 99%

Long-term macrolide treatment for chronic respiratory disease

2012

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Long-term macrolide treatment was first shown to alter the natural history of diffuse panbronchiolitis (DPB) in the late 1980s. Since then, macrolides have been demonstrated to exert antiinflammatory and immunomodulatory activity in addition to being antimicrobial. Indeed, their spectrum of action extends to the regulation of leukocyte function and production of inflammatory mediators, control of mucus hypersecretion, resolution of inflammation and modulation of host defence mechanisms. As such, the potential benefit of macrolide antibiotics has been evaluated in a variety of chronic respiratory diseases. The best studied condition is cystic fibrosis, of which there have been six randomised controlled trials showing evidence of benefit. However, most of the studies were limited by small numbers of patients and short follow-up. More recently, landmark studies have demonstrated the efficacy of azithromycin in reducing the risk of acute exacerbations in patients with chronic obstructive pulmonary disease, but the optimal duration and dosing of macrolide treatment remain uncertain.With the exception of patients with DPB and cystic fibrosis, until clear evidence of efficacy is available, the long-term use of macrolides should be limited to highly selected patients after careful evaluation of benefit and harm, or in the context of randomised controlled clinical trials. @ERSpublications Several studies evaluating macrolide antibiotics for the treatment of chronic respiratory diseases are underway

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Section: Chronic Rhinosinusitismentioning

confidence: 99%

Long-term macrolide treatment for chronic respiratory disease

2012

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“…Videler et al 753 examined CRSsNP patients and CRSwNP patients with low-grade polyps using a similar combination of patient-reported outcome and objective measures and found that azithromycin 500 mg/week after an initial loading dose showed no benefit over placebo. Notably, CRSwNP patients comprised 52% of the 60 subjects.…”

Section: Viie4 Crssnp Management: Antibioticsmentioning

confidence: 99%

“…Gastrointestinal disorders including mild diarrhea, vague abdominal discomfort, or nausea and vomiting were most common, reported in less than 5% of all patients. 753,754,761 In non-sinus studies, macrolides have been implicated in causing ototoxicity 764 and liver dysfunction. 765 Concerns about overuse resulting in host antibiotic resistance have been raised.…”

Section: Viie4 Crssnp Management: Antibioticsmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

557

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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“…There was a favorable response in the roxithromycin treatment group in terms of patient response score (Ϫ0.73 points; 1-6 point scale) and a decrease in SNOT-20 scores at the end of treatment compared with placebo. 21 However, a study published by Videler et al, 22 23 the strength of recommendation for systemic antibiotic use in the treatment of CRSsNP is C (based on evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case control studies). However, there is stronger evidence for the benefit of macrolide treatment in patients with CRS and normal IgE levels.…”

Section: Antimicrobialsmentioning

confidence: 99%