A systematic review and meta-analysis of the role of doxycycline in chronic rhinosinusitis

Abstract

Objective The objective of this systematic review and meta-analysis was to evaluate the role of doxycycline in the management of chronic rhinosinusitis. Method This was a systematic review using Ovid Medline, Cinahl, Scopus and Cochrane and was limited to meta-analyses, systematic reviews and randomised, clinical trials. A combination of the following search terms was used: ‘sinusitis’, ‘nasal polyps’, ‘doxycycline’ and ‘tetracycline’. Raw means and standard deviations were extracted from the included studies. The meta-analysis was performed using mean differences of pre- versus post-doxycycline treatment. Results A total of 279 studies were screened, of which 5 studies met the criteria (all randomised, controlled trials published between 2010 and 2021). The interventions, endpoints and measured outcomes varied across all studies. Meta-analysis performed on pre- versus post-doxycycline treatment for Sino-Nasal Outcome Test-22, nasal polyp scores and symptom scores did not yield statistically significant results. Conclusion This review identified a small number of high-quality studies on the use of doxycycline in chronic rhinosinusitis. There does not seem to be convincing evidence for the routine use of doxycycline in patients with chronic rhinosinusitis. Further research may try to identify certain phenotypes of chronic rhinosinusitis that may better respond to doxycycline.

Outcome measures for chronic rhinosinusitis with nasal polyps

“…Although a recent systematic review with meta-analysis did not find significant CRS treatment effects for doxycycline (361) , one…”

Non-antibiotic antimicrobial agents for chronic rhinosinusitis: a narrative review

“…Antibiotics may be suitable for bacterial CRS or post-surgery cases but are generally ineffective in improving symptoms or endoscopic aspects in most CRS cases. 4 , 9 , 10 Antibiofilm therapy may alleviate inflammation in CRS by targeting biofilm colonization, reducing acute exacerbations. 10 , 11 To minimize antibiotic side effects in CRS, alternative antimicrobial/antibiofilm therapies, supported by in vitro and preclinical studies, have been explored.…”

The effect of nasal douching by hypertonic 2.3 per cent sea water with algae extracts on the concentration of epidermal growth factor, transforming growth factor-α and interleukin-8 in nasal secretions of patients with nasal polyposis following endoscopic surgical treatment

“…1,2 According to the results of numerous studies, functional endoscopic sinus surgery (FESS), administration of topical and systemic corticosteroids, long-term low-dose use of macrolide antibiotics and doxycycline, as well as biologic therapy are the principles of nasal polyposis treatment. [1][2][3][4][5] Also, according to modern guidelines for the treatment of chronic rhinosinusitis, rinsing the nasal cavity with saline solutions is a mandatory part of the therapy, especially in the period after FESS. 1,2,6 Although the efficacy of FESS has been confirmed within the past three decades, delayed nasal mucosal healing and formation of adhesions following FESS, especially in the region of the middle nasal meatus, can be a potential cause of surgical failure, including blockage of mucociliary clearance and the recurrence of the sinus disease.…”

“… 1 , 2 According to the results of numerous studies, functional endoscopic sinus surgery (FESS), administration of topical and systemic corticosteroids, long-term low-dose use of macrolide antibiotics and doxycycline, as well as biologic therapy are the principles of nasal polyposis treatment. 1 – 5 Also, according to modern guidelines for the treatment of chronic rhinosinusitis, rinsing the nasal cavity with saline solutions is a mandatory part of the therapy, especially in the period after FESS. 1 , 2 , 6 …”