Is there a role for antibiotics in the treatment of chronic rhinosinusitis?

Smith, Stephanie Shintani; Kim, Woojin; Douglas, Richard

doi:10.1016/j.jaci.2022.02.004

Cited by 10 publications

(14 citation statements)

References 125 publications

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“…Guidelines differ as to whether antibiotics should be included in the treatment regimen for patients with CRS; this is due to insufficient evidence confirming their effectiveness and an incomplete understanding of the role of microorganisms in the pathogenesis of CRS [ 92 ].…”

Section: The Problem In the Treatment Of Crs—antibiotic Resistancementioning

confidence: 99%

Chronic Rhinosinusitis—Microbiological Etiology, Potential Genetic Markers, and Diagnosis

Michalik,

Krawczyk

2024

IJMS

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Chronic rhinosinusitis (CRS) is a significant public health problem. Bacterial colonization and impaired mucociliary clearance play a significant role in the inflammatory process. Several inflammatory pathways and host defense elements are altered in CRS, which may contribute to observed differences in the microbiome. To date, researching CRS has been difficult due to limited access to the studied tissue and a lack of available biomarkers. Ongoing scientific research is increasingly based on simple and objective analytical methods, including sensors, detection with PCR, and sequencing. Future research on microbiota and human factors should also include genomics, transcriptomics, and metabolomics approaches. This report analyzes the changes that occur in the paranasal sinuses of people with acute and chronic rhinosinusitis, the composition of the microbiota, the human genetic markers that may shed light on the predisposition to CRS, and the advantages and disadvantages of classical and molecular diagnostic methods, as well as addressing the difficulties of sinusitis treatment.

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Section: The Problem In the Treatment Of Crs—antibiotic Resistancementioning

confidence: 99%

Chronic Rhinosinusitis—Microbiological Etiology, Potential Genetic Markers, and Diagnosis

Michalik,

Krawczyk

2024

IJMS

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“…The benefit of low-dose long-term macrolide therapy has been studied in non-type 2 CRSsNP, particularly in patients with low total IgE levels (< 200 μg) [45]. Macrolides reduce inflammatory markers through antibacterial and anti-inflammatory actions, change the properties of mucus, and improve endoscopic and imaging findings of CRS [46]. Recently, the effectiveness of low-dose long-term macrolides on refractory CRSwNP has been discussed, but its effectiveness remains controversial and requires a well-designed controlled study [47,48].…”

Section: Tailored Management In Asian Crswnpmentioning

confidence: 99%

Endotypes of Asian chronic rhinosinusitis with nasal polyps: A narrative review

Ryu¹,

Kim²,

Jung³

et al. 2022

Precis Future Med

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Chronic rhinosinusitis (CRS) is classified as CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP is a distinct phenotype with heterogeneous endotypes and complex pathophysiological mechanisms. Inflammation of the sinonasal mucosa that forms NPs causes symptoms such as nasal obstruction, rhinorrhea, and smell loss, and lowers patients' quality of life. In recent years, researchers have attempted to elucidate the inflammatory endotypes of CRSwNP, and the inflammatory pattern of Asian CRSwNP was found to be different from that of Western CRSwNP. The main endotype of CRSwNP is type 2 inflammation, in which interleukin (IL)-4, IL-5, and IL-13 are key cytokines. In contrast, type 1 inflammation (interferon-γ) and type 3 inflammation (IL-17 or IL-22) play essential roles in Asian CRSwNP. Biological agents, which have recently been highlighted for the treatment of CRSwNP, are very effective in suppressing the type 2 inflammatory response and recovering smell loss. However, little information is available on the efficacy of these biologics in Asian patients with CRSwNP. Herein, we reviewed the endotypes of Asian CRSwNP and compared them to those of Western CRSwNP. We identified changes in the inflammatory patterns and summarized the therapeutic options for Asian CRSwNP.

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“…Moriyama et al reported that post-operative LDLT erythromycin showed better improvement of clinical symptoms and endoscopic findings compared to the non-treated group [18]. Since then, LDLT macrolides, including 14-membered lactone erythromycin, roxithromycin, clarithromycin, and 15-membered azithromycin [19], have been studied in various clinical trials and have been frequently prescribed to patients with CRS [20,21]. The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012 guidelines recommended LDLT macrolide treatment for CRSsNP patients with normal total IgE levels [22].…”

Section: Introductionmentioning

confidence: 99%

“…However, the prescription of macrolide-based treatment for CRS is emerging, and the frequency of prescription is high in actual clinical practice [25]. Macrolide antibiotics are the second most prescribed drug after penicillin/beta-lactams in the United States and are also preferred by doctors at university hospitals in South Korea [20,21].…”

Section: Introductionmentioning

confidence: 99%

The Mechanism of Action and Clinical Efficacy of Low-Dose Long-Term Macrolide Therapy in Chronic Rhinosinusitis

Ryu

Lee

Park

et al. 2023

IJMS

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Various chronic inflammatory airway diseases can be treated with low-dose, long-term (LDLT) macrolide therapy. LDLT macrolides can be one of the therapeutic options for chronic rhinosinusitis (CRS) due to their immunomodulatory and anti-inflammatory actions. Currently, various immunomodulatory mechanisms of the LDLT macrolide treatment have been reported, as well as their antimicrobial properties. Several mechanisms have already been identified in CRS, including reduced cytokines such as interleukin (IL)-8, IL-6, IL-1β, tumor necrosis factor-α, transforming growth factor-β, inhibition of neutrophil recruitment, decreased mucus secretion, and increased mucociliary transport. Although some evidence of effectiveness for CRS has been published, the efficacy of this therapy has been inconsistent across clinical studies. LDLT macrolides are generally believed to act on the non-type 2 inflammatory endotype of CRS. However, the effectiveness of LDLT macrolide treatment in CRS is still controversial. Here, we reviewed the immunological mechanisms related to CRS in LDLT macrolide therapy and the treatment effects according to the clinical situation of CRS.

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Is there a role for antibiotics in the treatment of chronic rhinosinusitis?

Cited by 10 publications

References 125 publications

Chronic Rhinosinusitis—Microbiological Etiology, Potential Genetic Markers, and Diagnosis

Chronic Rhinosinusitis—Microbiological Etiology, Potential Genetic Markers, and Diagnosis

Endotypes of Asian chronic rhinosinusitis with nasal polyps: A narrative review

The Mechanism of Action and Clinical Efficacy of Low-Dose Long-Term Macrolide Therapy in Chronic Rhinosinusitis

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