Advertisement

Clarithromycin in the Management of Chronic Rhinosinusitis: Preliminary Results of a Possible Its New Use

  • F. Sireci
  • R. Speciale
  • S. Gallina
  • R. Sorrentino
  • F. R. Canevari
Original Article
  • 95 Downloads

Abstract

The aim of this study is to evaluate the efficacy and safety of prolonged therapy with low-dose clarithromycin in patients with chronic rhinosinusitis with polyps (CRSwP) after endoscopic sinus surgery (ESS). A total of 10 patients with CRSwP were identified and subjected to bilateral ESS. In post-operative patients they were treated with nasal wash with saline solution and steroid sprays (beclomethasone). During follow-up, after 30–40 days after the operation (M = 35.4 SD = +4.33), patients reported a worsening of symptoms with onset of nasal obstruction; reduction/loss of smell; headache; onset of viscous secretions and therefore all patients continued therapy with saline nasal irrigation, topical steroid therapy and started macrolide (clarithromycin 500 mg/pill: 1 pill/day for 3 days a week for 1 month). 22-item SinoNasal Outcome Test (SNOT-22) and a score to the endoscopic evaluation (endoscopic appearance score, EAS) before and after treatment were performed to evaluate efficacy of treatment. The results of the SNOT-22 and EAS showed statistically significant improvements (p < 0.05) for some parameters such as: the need to blow nose, sneezing, hyposmia, viscous mucous secretions about the SNOT-22 and reduction of secretions and edema of the nasal mucosa about the EAS. The preliminary results of our study show that the low-dose clarithromycin for a period of 1 month can improve patient complaints with CRSwP not only through the antibacterial properties but also for the immunomodulatory characteristics.

Keywords

Chronic rhinosinusitis with polyps Clarithromycin Eosinophil 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest in the preparation of this article.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

References

  1. 1.
    Hedman J, Kaprio J, Poussa T, Nieminen MM (1999) Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol 28:717–722CrossRefPubMedGoogle Scholar
  2. 2.
    Settipane G (1997) Epidemiology of nasal polyps. In: Settipane G, Lund VJ, Bernstein JM, Tos M (eds) Nasal polyps: epidemiology, pathogenesis and treatment. Oceanside Publications, Providence, pp 17–24Google Scholar
  3. 3.
    Ogino S, Harada T, Okawachi I, Irifune M, Matsunaga T, Nagano T (1986) Aspirin-induced asthma and nasal polyps. Acta Otolaryngol Suppl 430:21–27PubMedGoogle Scholar
  4. 4.
    Fokkens W, Lund V, Mullol J (2007) European position paper on rhinosinusitis and nasal polyps group. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl 20:1–136PubMedGoogle Scholar
  5. 5.
    Martines F, Salvago P, Ferrara S, Messina G, Mucia M, Plescia F et al (2016) Factors influencing the development of otitis media among Sicilian children affected by upper respiratory tract infections. Braz J Otorhinolaryngol 82(2):215–222CrossRefPubMedGoogle Scholar
  6. 6.
    Martines F, Salvago P, Ferrara S, Mucia M, Gambino A, Sireci F (2014) Parietal subdural empyema as complication of acute odontogenic sinusitis: a case report. J Med Case Rep 21(8):282CrossRefGoogle Scholar
  7. 7.
    Desrosiers MY, Kilty SJ (2008) Treatment alternatives for chronic rhinosinusitis persisting after ESS: what to do when antibiotics, steroids and surgery fail. Rhinology 46:3–14PubMedGoogle Scholar
  8. 8.
    Kudoh S, Uetake T, Hagiwara K, Hirayama M, Hus LH, Kimura H et al (1984) Clinical effect of low-dose, long-term erythromycin chemotherapy on diffuse panbronchiolitis (English Abstract). Jpn J Thorac Dis 25:632–642Google Scholar
  9. 9.
    Kudoh S, Asuma A, Yamamoto M, Izumi T, Ando M (1998) Improvement of survival in patients with diffuse panbronchiolitis treated with low-dose erythromycin. Am J Respir Crit Care Med 157:1829–1832CrossRefPubMedGoogle Scholar
  10. 10.
    Cervin A, Wallwork B (2007) Macrolide therapy of chronic rhinosinusitis. Rhinology 45:259–267PubMedGoogle Scholar
  11. 11.
    Cervin A, Wallwork B, Mackay-Sim A, Coman WB, Greiff L (2009) Effects of long-term clarithromycin treatment on lavage-fluid markers of inflammation in chronic rhinosinusitis. Clin Physiol Funct Imaging 29:136–142CrossRefPubMedGoogle Scholar
  12. 12.
    Canevari FR, Giourgos G, Pistochini A (2014) The endoscopic transnasal paraseptal approach to a sphenoid sinus osteoma: case report and literature review. Ear Nose Throat J. 2013 Dec; 92(12): E7–E10. Review. Erratum in: Ear Nose Throat J 93(4–5):148Google Scholar
  13. 13.
    Vitali M, Canevari FR, Cattalani A, Grasso V, Somma T, Barbanera A (2016) Direct fascia lata reconstruction to reduce donor site morbidity in endoscopic endonasal extended surgery: a pilot study. Clin Neurol Neurosurg 144:59–63CrossRefPubMedGoogle Scholar
  14. 14.
    Piccirillo J, Merritt M, Richards M (2001) Psychometric and clinimetric validity of the 20-item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg 126:41–47CrossRefGoogle Scholar
  15. 15.
    Lund VJ, Mackay IS (1993) Staging in rhinosinusitus. Rhinology 31:183–184PubMedGoogle Scholar
  16. 16.
    Inanli S, Tutkun A, Batman C, Okar I, Uneri C, Sehitoglu MA (2000) The effect of endoscopic sinus surgery on mucociliary activity and healing of maxillary sinus mucosa. Rhinology 38:120–123PubMedGoogle Scholar
  17. 17.
    Fujita K, Shimizu T, Majima Y, Sakakura Y (2000) Effects of macrolides on interleukin- 8 secretion from human nasal epithelial cells. Eur Arch Otorhinolaryngol 257:199–204CrossRefPubMedGoogle Scholar
  18. 18.
    Wallwork B, Coman W, Mackay-Sim A, Greiff L, Cervin A (2006) A double-blind, randomized, placebo-controlled trial of macrolide in the treatment of chronic rhinosinusitis. Laryngoscope 116:189–193CrossRefPubMedGoogle Scholar
  19. 19.
    Fang SY (1994) Normalization of maxillary sinus mucosa after FESS. A prospective study of chronic sinusitis with nasal polyps. Rhinology 32:137–140PubMedGoogle Scholar
  20. 20.
    Varvyanskaya A, Lopatin A (2014) Efficacy of long-term low-dose macrolide therapy in preventing early recurrence of nasal polyps after endoscopic sinus surgery. Int Forum Allergy Rhinol 4(7):533–541CrossRefPubMedGoogle Scholar
  21. 21.
    Kikuchi S, Susaki H, Aoki A, Ito O, Nomura Y (1991) Clinical effect of long-term lowdose erythromycin therapy for chronic sinusitis. Pract Otlo 84:41–47CrossRefGoogle Scholar
  22. 22.
    Hashiba M, Baba S (1996) Efficacy of long-term administration of clarithromycin in the treatment of intractable chronic sinusitis. Acta Otolaryngol Suppl 525:73–78PubMedGoogle Scholar
  23. 23.
    Videler WJ, Badia L, Harvey RJ, Gane S, Georgalas C, van der Meulen FW et al (2011) Lack of efficacy of long term, low-dose azithromycin in chronic rhinosinusitis: randomized controlled trial. Allergy 66:1457–1468CrossRefPubMedGoogle Scholar
  24. 24.
    Cervin A, Kalm O, Sandkull P, Lindberg S (2002) One-year low-dose erythromycin treatment of persistent chronic sinusitis after sinus surgery: clinical outcome and effects on mucociliary parameters and nasal nitric oxide. Otolaryngol Head Neck Surg 126:481–489CrossRefPubMedGoogle Scholar
  25. 25.
    Peric A, Vojvodic D, Baletic N, Peric A, Miljanovic O (2010) Influence of allergy on the immunomodulatory and clinical effects of long-term low-dose macrolide treatment of nasal polyposis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 154:327–333CrossRefPubMedGoogle Scholar
  26. 26.
    Nakamura Y, Suzuki M, Yokota M, Ozaki S, Ohno N, Hamajima Y et al (2013) Optimal duration of macrolide treatment for chronic sinusitis after endoscopic sinus surgery. Auris Nasus Larynx 40:366–372CrossRefPubMedGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  • F. Sireci
    • 1
  • R. Speciale
    • 1
  • S. Gallina
    • 1
  • R. Sorrentino
    • 2
  • F. R. Canevari
    • 2
  1. 1.Otorhinolaryngology Section, Department of Experimental Biomedicine and Clinical Neurosciences, (BioNeC)University of PalermoPalermoItaly
  2. 2.Otorinolaryngology SectionSS Antonio Biagio e Cesare Arrigo HospitalAlessandriaItaly

Personalised recommendations