Biofilms in chronic rhinosinusitis with polyps: is eradication possible?

Abstract

The objective of the study was to reveal if mometasone furoate nasal spray as monotherapy or combined with long-term oral clarithromycin have influence on biofilms in chronic rhinosinusitis with polyps. The study is a randomized controlled trial in a tertiary referral hospital. Thirty-four patients with chronic rhinosinusitis completed the study. In the first group, 19 patients received mometasone furoate nasal spray 200 μg once daily for 8 weeks. In the second group, 15 patients received oral clarithromycin 500 mg twice daily for 2 weeks and continued once daily 250 mg tablet for subsequent 6 weeks, plus mometasone furoate. Scanning electron microscopy was the primary outcome measure. Secondary outcome measures included computerized tomography and sinonasal outcome test-20 items. Mucosal biofilms were detected in 23 of 34 (68%) patients on pretreatment polyp samples. After the treatment, biofilms disappeared in 1 of 11 patients in the first group, whereas the eradication of biofilms was evident in 6 of 12 (50%) patients in the second group. Tomography scores improved in eight patients of each group (42.1 and 53.4%, respectively). The comparison of improvements did not reveal significant difference between the groups. The overall symptom scores improved compared to the baseline levels. The mean changes of -8.8421 and -11.4000 in the first and second group, respectively, were not statistically different. Adding long-term low-dose oral macrolides to nasal steroids was effective in the eradication of biofilm. However, we were not able to demonstrate that combined therapy was superior in terms of the improvement in tomography and symptom scores.

Clarithromycin for the treatment of adult chronic rhinosinusitis: a systematic review and meta‐analysis

“…After assessing 94 full‐text articles for eligibility, an additional 77 studies were excluded. Finally, 17 RCTs with 1738 participants were included in this systematic review (Fig. ), and 16 RCTs with available data were included in the meta‐analysis (Table ).…”

“…The sample size of each included study ranged from 43 to 345. Fifteen studies were conducted in China, 1 study was conducted in Turkey, and 1 study was conducted in Russia . All studies reported using systemic treatment with oral clarithromycin.…”

“…Eleven studies compared additional oral clarithromycin to nasal glucocorticoid spray with or without nasal saline irrigation vs nasal glucocorticoid spray with or without nasal saline irrigation alone. Among them, only 1 study used endoscopic score (Chinese endoscopic scoring system) rather than Lund‐Kennedy endoscopic score to evaluate efficacy.…”

“…For instance, 1 study showed that compared with nasal glucocorticoid spray alone, the addition of oral clarithromycin to nasal glucocorticoid spray was associated with a better nasal endoscopic evaluation and paranasal sinuses CT findings . However, another study found that the effect of combination oral clarithromycin and nasal mometasone furoate spray was similar to nasal mometasone furoate spray alone based on paranasal sinuses CT findings . Hence, our systematic review and meta‐analysis addressed these questions by systematically collecting relevant RCTs and pooling their results where applicable.…”

Understanding the Role of Biofilms and Superantigens in Chronic Rhinosinusitis

“…While overall biofilm prevalence decreased with treatment in both groups (75% vs 43.8%), and post-treatment grade was significantly decreased in both groups (median difference = 1.0, p <0.01), no additional benefit was found for adding intranasal steroid to oral macrolide therapy in CRSwNP [11]. In a similar RCT, Korkmaz et al compared the efficacy of intranasal steroid as monotherapy versus combined with low-dose oral macrolide in 34 CRSwNP patients [70]. The combined macrolide and intranasal steroid group had significant reduction of biofilm compared to control but the intranasal steroid group alone did not.…”