Evaluation of Long-Term Clarithromycin Treatment in Adult Chinese Patients with Chronic Rhinosinusitis without Nasal Polyps

Abstract

Objective: To evaluate the efficacy of long-term clarithromycin (CAM) treatment in adult Chinese patients suffering from chronic rhinosinusitis without nasal polyps (CRSnNP). Methods: Thirty-three CRSnNP patients were enrolled and subjected to CAM treatment for 12 weeks (250 mg daily). The total nasal symptom scores (TNSS), nasal resistance and inflammatory mediators including interleukin (IL)-8 and myeloperoxidase (MPO) were evaluated at weeks 0 and 12. Quality of life (QoL) was assessed in all patients by using the Sinonasal Outcome Test 20 and Short Form 36 questionnaires. Results: CAM treatment significantly improved TNSS, nasal resistance and QoL, and it inhibited IL-8 and MPO production in CRSnNP patients (p < 0.05). CAM treatment was more effective for IL-8^high CRSnNP patients than for IL-8^low CRSnNP patients (p < 0.05). Conclusion: Long-term, low-dose CAM treatment is effective and safe for the treatment of CRSnNP in Chinese patients.

High and low doses of clarithromycin treatment are associated with different clinical efficacies and immunomodulatory properties in chronic rhinosinusitis

“…5,6,[11][12][13] Macrolide therapy has been shown to have a slow onset, with ongoing improvement until several months after the start of therapy. 3 However, we have observed significant clinical improvement in chronic rhinosinusitis patients after clarithromycin Data values represent median scores and interquartile ranges.…”

“…As we have previously described, the Sino-Nasal Outcome Test 20 is a validated, rhinosinusitis-specific QoL instrument, in which patients are asked to answer 20 questions regarding their nasal symptoms and QoL. 6 Cytokine levels. Nasal secretions were collected (in the manner previously described 6 ) at the three time points.…”

“…4,5 For example, macrolides demonstrate immunomodulatory capacities by inhibiting cytokines such as interleukin (IL)-8, thereby suppressing neutrophil migration and adhesion, and modulating mucus synthesis and secretion. 3 Several reports, [3][4][5] including our previous study, 6 have thus suggested that long-term, low-dose macrolide treatment may be most beneficial in chronic rhinosinusitis patients with a neutrophilic inflammatory pattern and low levels of immunoglobulin (Ig) E.…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…As has been seen previously, 754 patients with AR did not have as robust a response to macrolide therapy. Luo et al 759 treated CRSsNP patients with clarithromycin and found improved nasal symptom scores, as well as reductions in IL-8 and myeloperoxidase in nasal secretions. Macrolide therapy was found to be more effective in patients with high IL-8 levels prior to treatment.…”

Regulation of Transforming Growth Factor-β1 Activation and Expression in the Tissue Remodeling Involved in Chronic Rhinosinusitis

“…Further, some patients are nonresponders after treatment with corticosteroids for 3 months and receive a functional endoscopic sinus surgery. The recourse required by these patients implies that the level of TGF-β1 is not modulated by corticosteroid treatment, indicating that corticosteroids show no effect on TGF-β1 expression in CRS, as suggested by the results of computed tomography/endoscopy, histopathologic examination, and patients’ complaints [35,36,37]. …”