Macrolide antibiotics in the treatment of chronic rhinosinusitis: evidence from a meta-analysis

Abstract

Background: The purpose of this study was to systematically assess the subjective and objective outcomes of macrolide therapy for chronic rhinosinusitis (CRS). Methods: PubMed, Embase and Cochrane databases were searched for clinical trials detailing the effects of macrolide therapy in patients with CRS and published up to December 2017. Sino-Nasal Outcome Test (SNOT), endoscopic scores and computed tomography scans (CT) scores were assessed by mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval. Subgroup analyses were performed to evaluate the source of heterogeneity according to study design and geographic locations. I 2 metric was used to assess the heterogeneity. Results: Seven randomised clinical trials (RCTs) and four cohort trials meeting pre-determined selection criteria were enrolled in this meta-analysis. Assessment of the findings for SNOT after 12 weeks' macrolide treatment demonstrated a significant improvement in subgroup of trials in Asian patients (SMD =−0.51; 95% CI: −0.96, −0.02; P=0.04), but not in non-Asians (SMD =−0.01; 95% CI: −0.65, 0.63; P=0.98). At 12 or 24 weeks' visit no significant difference in SNOT was noted compared with control group, either in RCTs or cohort trials subgroups. However, findings for endoscopic scores were found to be significantly improved compared to placebo in the subgroup of non-RCT studies after 8 weeks (SMD =−0.77; 95% CI: −1.07, −0.46; P<0.00001) and 12 weeks (SMD=−1.40; 95% CI: −1.97, −0.82; P<0.00001) of macrolide therapy. Similarly, findings for CT scores showed significant improvements in CT scores compared to baseline after 12 weeks' treatment (MD=−5.81; 95% CI: −8.10, −3.52; P<0.00001) in cohort trials.Conclusions: Macrolide therapy can significantly improve endoscopic and CT scores in CRS patients, compared to baseline. Further well-designed studies are needed to confirm the efficacy and safety of macrolides in CRS treatment.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…However, the high antibiotic dose group (more than 29 days out of 90 days prior to ESS) was relatively less improved 1961 . In addition, macrolide therapy was reported effective 1105,1121,1962 . Moreover, several studies in CRSsNP patients have found that short term (9‐14 days) use of antibiotics improved clinical symptoms with no significant difference in several types of antibiotics 1102–1104 .…”

Factors of success of low‐dose macrolides in chronic sinusitis: Systematic review and meta‐analysis

“…Lasso et al pooled data from four RCTs and showed no difference between the effects of LDMs and placebo. The recent meta‐analysis by Shen et al included both randomized and nonrandomized controlled trials. Forest plots from the RCTs did not show the benefit of LDMs therapy.…”

Is bronchiectasis really a disease?

“…Therapeutic modalities with established efficacy in bronchiectasis are also far from specific and beneficial in other airway diseases. Macrolides have proven efficacy in reducing exacerbations in CF [101], but also in diffuse panbronchiolitis [102,103], bronchiolitis obliterans in lung transplant recipients [104][105][106], COPD [107][108][109], CRS [110] and, recently, asthma [111]. Airway clearance and inhaled mucolytic agents, such as hypertonic saline, are the first-line treatment for CF [112].…”