One‐Year Low‐Dose Erythromycin Treatment of Persistent Chronic Sinusitis after Sinus Surgery: Clinical Outcome and Effects on Mucociliary Parameters and Nasal Nitric Oxide

Cervin, Anders; Kalm, Olof; Sandkull, Per; Lindberg, Staffan I.

doi:10.1067/mhn.2002.124849

Cited by 82 publications

(56 citation statements)

References 18 publications

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“…Unfortunately, the subjective complaints did not correlate with these findings. Using VAS scores, subjective complaints did decrease as did objective measurements in relation to an increase in clearance time (106). Some critical notes should be made regarding any causal relation.…”

Section: Objective Methodsmentioning

confidence: 99%

Evidence‐based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system

Spronsen

Ingels

Jansen

et al. 2008

Allergy

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Nasal congestion is an important symptom in nasal pathology and can be defined as an objective restriction of nasal cavity airflow because of mucosal pathology and/or increased mucus secretion (excluding anatomical variants). Using the new Grading Recommendations Assessment, Development and Evaluation system, evidence‐based recommendations are made that will encompass different clinical questions regarding diagnostic modalities of nasal congestion: (i) their usefulness in assessment of presence and severity of congestion; (ii) their usefulness in assessment of etiological pathology responsible for congestion; and (iii) their usefulness in follow up and treatment effectiveness evaluation of nasal congestion.

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Section: Objective Methodsmentioning

confidence: 99%

Evidence‐based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system

Spronsen

Ingels

Jansen

et al. 2008

Allergy

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“…For example, a prospective open-label study of 17 patients with persistent sinusitis following sinus surgery, using erythromycin treatment, showed significant improvements in saccharin transit time and symptoms, including nasal congestion, rhinitis and headache, at 3 and 12 months of follow-up [41]. The first double-blind randomised placebo-controlled study examining the effects of low-dose macrolide therapy in chronic rhinosinusitis was reported in 2006 [43].…”

Section: Chronic Rhinosinusitismentioning

confidence: 99%

“…Macrolide treatment of chronic rhinosinusitis has been investigated in several open-label studies [40][41][42]. For example, a prospective open-label study of 17 patients with persistent sinusitis following sinus surgery, using erythromycin treatment, showed significant improvements in saccharin transit time and symptoms, including nasal congestion, rhinitis and headache, at 3 and 12 months of follow-up [41].…”

Section: Chronic Rhinosinusitismentioning

confidence: 99%

Long-term macrolide therapy in chronic inflammatory airway diseases

Crosbie¹,

Woodhead²

2009

European Respiratory Journal

119

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In addition to direct antibacterial actions, 14-and 15-member-ring macrolides have immune modulating effects that appear to be the reason for clinical benefit in diffuse panbronchiolitis.A literature search was conducted for studies of the clinical effectiveness of macrolides in other chronic lung conditions.A number of studies were identified that showed short-term beneficial outcomes or the potential for such outcomes in cystic fibrosis, bronchiectasis, chronic obstructive pulmonary disease, asthma and post-transplant obliterative bronchiolitis. The studies were limited by small patient numbers, different outcome measures and short-term follow-up, and were not designed to assess potentially harmful effects.Further large prospective and long-term studies are required in order to identify potential benefit and harm before these agents can be recommended routinely for these conditions.

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“…One study showed that response rate varied from 5% at 2 weeks to 71% at 12 weeks (15). A study performed by Cervin et al (4) showed that further improvement in res ponders was seen at 12 months compared to 3 months regarding mucociliary transport, postnasal drip and headache. The results of the bacterial cultures suggest that the risk of selecting resistant bacteria is low (4).…”

Section: Discussionmentioning

confidence: 99%

“…A study performed by Cervin et al (4) showed that further improvement in res ponders was seen at 12 months compared to 3 months regarding mucociliary transport, postnasal drip and headache. The results of the bacterial cultures suggest that the risk of selecting resistant bacteria is low (4). In a small number of patients the cultures were positive, but this was not always linked with an increase in symptoms, which could be due to the fact that in addition to the direct bacteriostatic effect of macro lides, they may in some cases reduce the virulence of bacteria without eradicating them (4).…”

Section: Discussionmentioning

confidence: 99%

Immunomodulatory and Clinical Effects of Long-Term Low-Dose Macrolide Treatment of Chronic Rhinosinusitis with Nasal Polyposis

Perić¹,

Vojvodić²,

Baletić³

et al. 2011

Journal of Medical Biochemistry

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Summary: Immunomodulatory treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP) by macrolide antibiotics represents a challenging alternative to conventional therapy and surgery, still being at the very beginning. Immune and inflammatory processes in nasal and paranasal sinus mucosa, crucial in the etiopathogenesis of nasal polyps (NPs) are reflected in levels of various local mediators, found both in mucosa and nasal fluid. In this prospective study, we assessed the immunomodulatory and clinical effects of longterm low-dose oral macrolide treatment in the management of CRSwNP. Twenty-two (n = 22) nonasthmatic, nonallergic patients with CRSwNP were administered clarithromycin (CAM) 500 mg/day single oral dose for eight weeks. We measured the levels of proinflammatory cytokines TNF-a, TNF-b, and IL-1b, Th1 cytokines IL-2, IL-12, and IFN-g, Th2 cytokines IL-4, IL-5, IL-6, and IL-10, and chemokine IL-8 in the nasal fluid samples, before and after treatment, using a flow cytometric method. We also scored each of the 22 patients before and after therapy according to Tsicopoulos' global nasal symptom score and Malm's endoscopic score. Following treatment, we found significantly reduced levels of IL-8 (p<0.01) and TNF-a (p<0.01) in nasal secretions. Macrolide therapy decreased the size of polyps in 45.45% of the patients. We concluded that long-term low-dose treatment with CAM was effective in the management of Kratak sadr`aj: Mada je u samim za~e cima, imunomo dulacijska terapija hroni~nog rinosinuzitisa sa nosnom poli pozom (HRSsNP) primenom makrolidnih anti biotika bi mogla predstavljati alternativu uobi~ajenoj konzer va tivnoj terapiji, kao i hirur{kom le~enju. Imunski i zapaljen ski procesi u sluzoko`i nosa i paranazalnih sinusa, naj zna ~ajniji u etiopato genezi nosnih polipa, reflektuju se na razli~ite lokalne medijatore, detektovane u sluzoko`i kao i u nosnom sekretu. U ovoj prospektivnoj studiji procenili smo imunomo dulacijske i klini~ke efekte dugotrajne niskodozirane oralne primene makrolidnog antibiotika u le~enju HRSsNP. Dva deset dvoje (n = 22) neastmati~nih, nealergi~nih pacijenata sa HRSsNP dobijalo je klaritromicin (CAM) u pojedina~noj dnevnoj dozi od 500 mg tokom osam nedelja. Merene su koncentracije proinflamatornih citokina TNF-a, TNF-b i IL-1b, Th1-cito kina IL-2, IL-12 i IFN-g, Th-2-citokina IL-4, IL-5, IL-6 i IL-10, kao i hemokina IL-8 u uzorcima nosnog sekreta, pre i nakon tera pije, primenom proto~ne citometrije. Svaki od pacijenata klini~ki je klasif i kovan pre i posle le~enja prema Tsicopoulosovom ukupnom nosnom simptom skoru i Malm-ovom endoskopskom skoru. Nakon le~enja, detektovane su znaajno ni`e koncentracije IL-8 (p<0,01) i TNF-a (p<0,01) u nosnom sekretu. Terapija makrolidnim antibio tikom je smanjila veli~inu polipa kod 45,45% od ukupnog bro ja paci jenata. Zaklju~eno je da je dugotrajna nisko dozirana primena

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One‐Year Low‐Dose Erythromycin Treatment of Persistent Chronic Sinusitis after Sinus Surgery: Clinical Outcome and Effects on Mucociliary Parameters and Nasal Nitric Oxide

Abstract: Long-term, low-dose erythromycin therapy seems to be a promising alternative when more conventional therapy fails. However, placebo-controlled studies are needed to validate the potential of this treatment.

Cited by 82 publications

References 18 publications

Evidence‐based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system

Evidence‐based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system

Long-term macrolide therapy in chronic inflammatory airway diseases

Immunomodulatory and Clinical Effects of Long-Term Low-Dose Macrolide Treatment of Chronic Rhinosinusitis with Nasal Polyposis

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