Controlled trial for long‐term low‐dose erythromycin after sinus surgery for chronic rhinosinusitis

Haxel, Boris; Clemens, Meike; Karaiskaki, Niki; Dippold, Uta; Kettern, Lisanne; Mann, Wolf J.

doi:10.1002/lary.25052

Cited by 45 publications

(111 citation statements)

References 25 publications

Supporting

Mentioning

106

Contrasting

Unclassified

Order By: Relevance

“…761 Both CRSsNP and CRSwNP patients treated with erythromycin had better endoscopy scores than control patients, but CRSsNP patients demonstrated a greater improvement with erythromycin compared to similarly treated CRSwNP patients. CRSsNP patients also showed trends toward greater improvement than CRSwNP patients in SNOT-20 scores, olfaction, and saccharin transit times.…”

Section: Viie4 Crssnp Management: Antibioticsmentioning

confidence: 84%

“…Gastrointestinal disorders including mild diarrhea, vague abdominal discomfort, or nausea and vomiting were most common, reported in less than 5% of all patients. 753,754,761 In non-sinus studies, macrolides have been implicated in causing ototoxicity 764 and liver dysfunction. 765 Concerns about overuse resulting in host antibiotic resistance have been raised.…”

Section: Viie4 Crssnp Management: Antibioticsmentioning

confidence: 99%

“…Haxel et al 761 used a DBRCT to examine the efficacy of macrolide in both CRSwNP and CRSsNP patients following sinus surgery. Both CRSwNP and CRSsNP patients were found to have improved endoscopy scores following 3 months of erythromycin 250 mg daily compared to controls.…”

Section: Viiie3 Crswnp Management: Oral Corticosteroidsmentioning

confidence: 99%

See 2 more Smart Citations

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

View full text Add to dashboard Cite

Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

show abstract

Section: Viie4 Crssnp Management: Antibioticsmentioning

confidence: 84%

Section: Viie4 Crssnp Management: Antibioticsmentioning

confidence: 99%

See 1 more Smart Citation

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

View full text Add to dashboard Cite

show abstract

“…During the study period, additional visits to the physician were allowed. Short-course (1-2 weeks) of intranasal steroid treatment after stop of study medication was permitted, but only under the situation of exacerbation of mild symptoms that usually followed common cold (29) . If polyps and/or the moderate to severe clinical symptoms of CRS were relapsed and/or not controlled after the stop of study medication, rescue therapy with oral prednisone tablets (30 mg daily on days 1-5, 20 mg daily on days 6-10, 10 mg daily on days 11-15, and 5 mg daily on days [16][17][18][19][20] was prescribed (30) .…”

Section: Methodsmentioning

confidence: 99%

Comparison of efficacy of fluticasone propionate versus clarithromycin for postoperative treatment of different phenotypic chronic rhinosinusitis: a randomized controlled trial

Zeng

Wang

Liao

et al. 2018

Rhin

View full text Add to dashboard Cite

Background: Chronic rhinosinusitis (CRS) can be divided to CRS without nasal polyps (CRSsNP) and eosinophilic and non-eosinophilic CRS with nasal polyps (CRSwNP). There is little evidence on the efficacy of glucocorticoids and macrolides in different phenotypic patients. The aim of this study was to compare the benefit of glucocorticoids and macrolides following endoscopic sinus surgery (ESS) in different phenotypic CRS. Methods:This study was a prospective single-blind comparative effectiveness trial. A total of 187 Chinese patients with CRS were stratified to CRSsNP and eosinophilic and non-eosinophilic CRSwNP group and then randomized to receive fluticasone propionate nasal spray at 200 μg or clarithromycin tablet at 250 mg once daily for 3 months after ESS. Oral prednisone was given as a rescue therapy after the stop of study medication. Patients were assessed before ESS and 1, 3, 6 and 12 months after dosing. Symptom severity was scored by patients using visual analog scale method and endoscopic findings were scored by the senior physician blinded to treatment according to European Position Paper on Rhinosinusitis and Nasal polyps 2012. Results:The total and individual symptom scores, and total and individual endoscopic domain scores were reduced significantly after ESS in both medication groups, whereas no significant difference was observed for two medications at most follow-up visits in each subtype of CRS. No difference in the frequency of subjects with rescue therapy or refractory CRS was found between two medication groups either. Conclusions:We could not show significant difference of effect between fluticasone propionate and clarithromycin in the postoperative treatment for CRSsNP and eosinophilic and non-eosinophilic CRSwNP patients.

show abstract

“…There are very few studies that have examined antibiotic use in CRS patients by RCTs using a placebo arm, and all have used macrolides or doxycycline-antibiotics known for their anti-inflammatory properties. Six major RCTs in adults are summarized in Table 4; all were small and had different inclusion criteria regarding [41][42][43][44][45][46] The control arm was a placebo in four studies but nasal corticosteroids in two. All 5 studies of macrolides evaluated long-term therapy (three months or more).…”

Section: Treatment With Systemic Antibioticsmentioning

confidence: 99%

The role of infection and antibiotics in chronic rhinosinusitis.

Barshak

Durand

2017

Laryngoscope Investig Oto

View full text Add to dashboard Cite

ObjectiveTo review the current understanding of the role of infection and antibiotics in chronic rhinosinusitis.Review methodsPubMed literature searchResultsChronic rhinosinusitis (CRS) in adults is an inflammatory condition and the role of infection is unclear. Biofilms are present in both CRS and normal patients so their role in CRS is unknown. Sinus cultures in CRS demonstrate a mixture of aerobic and anaerobic bacteria but may be hard to interpret due to contaminating nasal flora. Staphylococcus aureus is common in CRS patients but also present in 20‐30% of nasal cultures in the normal population; eradicating this organism did not lead to symptom improvement versus placebo in a randomized controlled trial (RCT). In CRS patients who develop an episode of acute rhinosinusitis (ARS), bacteria typical of ARS can generally be cultured and require short‐course treatment. For CRS, topical antibacterial or antifungal agents have shown no benefit over placebo in RCTs, although RCTs of topical antibacterial agents have been small. Oral macrolides and doxycycline, antibiotics with anti‐inflammatory properties, are the only systemic antibiotics that have been evaluated in RCTs. One RCT found 3 weeks of doxycycline beneficial in patients with polyps but follow up was short (<3 months); RCTs of prolonged macrolide therapy have produced mixed results, and most show no benefit after cessation of therapy. Long‐term antibiotic therapy may produce side effects and select increasingly resistant flora. The American Academy of Otolaryngology—Head and Neck Surgery guidelines recommend against treatment of CRS with antifungal agents but do not comment on the role of antibacterial treatment.ConclusionThe role of infection in CRS is unknown, and the only well‐defined role for antibiotics is for treatment of ARS episodes or their infectious complications.Level of EvidenceN/A.

show abstract

Controlled trial for long‐term low‐dose erythromycin after sinus surgery for chronic rhinosinusitis

Abstract: Ib.

Cited by 45 publications

References 25 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Comparison of efficacy of fluticasone propionate versus clarithromycin for postoperative treatment of different phenotypic chronic rhinosinusitis: a randomized controlled trial

The role of infection and antibiotics in chronic rhinosinusitis.

Contact Info

Product

Resources

About