Long-term antibiotics for Chronic Rhinosinusitis: changing views

Wj, Fokkens

doi:10.4193/rhin19.404

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…99 Overall, there is less evidence of efficacy of macrolides in CRSwNPs compared with CRSsNPs. 97,[99][100][101] The current data therefore do not support the routine use of antibiotics in patients with CRSwNP.…”

Section: Chronic Rhinosinusitis With Nasal Polypscontrasting

confidence: 76%

Yardstick for the medical management of chronic rhinosinusitis

Borish

Baroody

Kim

et al. 2022

Annals of Allergy, Asthma & Immunology

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Section: Chronic Rhinosinusitis With Nasal Polypscontrasting

confidence: 76%

Yardstick for the medical management of chronic rhinosinusitis

Borish

Baroody

Kim

et al. 2022

Annals of Allergy, Asthma & Immunology

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“…[19][20][21][22] To prevent postoperative fibrosis, MA can be considered when the nasal cavity is congested, swollen, or accompanied by purulent secretions, 23,24 especially for CRS without nasal polyps (CRSsNP). 25 Additionally, MA is beneficial to patients with CRS with nasal polyps (CRSwNP), especially those without tissue eosinophilia, as a postoperative medical therapy 26 14-and 15-ring MA exhibit various anti-inflammatory and immunomodulatory properties, 27 including the regulation of cytokines and transcription factors expression and synthesis 28 ; the reduction of IL-4, 8, and TNF-α secretion levels. 29 CLA, a representative drug of 14-ring MA, is often used after surgery.…”

Section: Discussionmentioning

confidence: 99%

Antibacterial and Anti‐inflammatory Effects of Clarithromycin‐Loaded Poly(l‐Lactide) Membrane in Rabbit Postoperation Model of Chronic Rhinosinusitis

Zhang

Chen

Zheng

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveMacrolide antibiotics are often used to prevent infection and inflammation after functional endoscopic sinus surgery for the treatment of chronic rhinosinusitis (CRS). The purpose of this study was to investigate the anti‐inflammatory and antibacterial effects of the clarithromycin‐loaded poly(‐lactide) (CLA‐PLLA) membrane and its mechanism.Study DesignRandomized controlled trial.SettingAnimal Experiment Center.MethodsWe compared the difference between poly(l‐lactide) (PLLA) and CLA‐PLLA membranes by observing the morphology of fibrous scaffolds, measuring water contact angle, tensile strength, and drug release capacity, and evaluating the antimicrobial activity of CLA‐PLLA. Twenty‐four rabbits were divided into a PLLA group and a CLA‐PLLA group after establishing CRS models. Another 5 normal rabbits comprised the control group. After 3 months, we placed the PLLA membrane in the nasal cavity of the PLLA group and the CLA‐PLLA membrane in the CLA‐PLLA group. Then, 14 days later, we evaluated the histological and ultrastructural changes in the sinus mucosa, protein, and messenger RNA (mRNA) levels of interleukin (IL)‐4, IL‐8, tumor necrosis factor‐α, transforming growth factor‐β1, α‐smooth muscle actin, and type I collagen.ResultsThe CLA‐PLLA membrane showed no significant difference in physical performance to the PLLA membrane, which continuously released 95% of the clarithromycin (CLA) for 2 months. The CLA‐PLLA membrane had significant bacteriostatic properties that can improve the morphology of mucosal tissues, and inhibit protein and mRNA expression of inflammatory cytokines. In addition, CLA‐PLLA also inhibited the expression of fibrosis‐associated marker molecules.ConclusionThe CLA‐PLLA membrane released CLA slowly and continuously, providing antibacterial, anti‐inflammatory, and antifibrotic effects in a rabbit model of postoperative CRS.

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“…If that was not enough, short courses of systemic corticosteroids [95] and/or surgery were used, followed by anti-inflammatory treatment once again. For patients with CRSsNP, long-term antibiotics were tried with varying degrees of success [96][97][98][99][100].…”

Section: Expert Opinionmentioning

confidence: 99%

Dupilumab for the treatment of chronic rhinosinusitis with nasal polyposis

Fokkens¹,

Lans²,

Reitsma³

2021

Expert Opinion on Biological Therapy

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Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) affects 1-2.5% of the population and is associated with significant adverse effects on quality of life (QoL). CRSwNP is strongly correlated with (late onset) asthma with 30-70% of the CRSwNP patients having asthma. Health-care spending in rhinosinusitis is high, especially because of indirect costs. Areas covered: In the last years, the recognition of endotyping as an essential presumption to precision medicine has significantly changed the integrated care pathways in the treatment of chronic rhinosinusitis. Dupilumab is the first biological available for the treatment of CRswNP, since late 2019. Treatment with dupilumab results in a significant improvement of QoL (measured as SNOT-22), rhinosinusitis disease severity, symptoms of rhinosinusitis, and especially sense of smell, nasal polyp score, Lund-Mackay CT score, and asthma outcomes (ACQ5 and FEV1) compared to placebo. Expert opinion: At this moment, the high cost of the treatment requires careful patient selection and within the EUFOREA and EPOS2020 context, experts have tried to give guidance based on today's data. We now need trials evaluating which patients benefit most from treatment with biologicals and in which patients the treatment is cost-effective.

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Long-term antibiotics for Chronic Rhinosinusitis: changing views

Cited by 6 publications

References 9 publications

Yardstick for the medical management of chronic rhinosinusitis

Yardstick for the medical management of chronic rhinosinusitis

Antibacterial and Anti‐inflammatory Effects of Clarithromycin‐Loaded Poly(l‐Lactide) Membrane in Rabbit Postoperation Model of Chronic Rhinosinusitis

Dupilumab for the treatment of chronic rhinosinusitis with nasal polyposis

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