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Macrolide therapy of chronic rhinosinusitis
1Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Lund University, Sweden. anders.cervin@med.lu.se
Rhinology
|December 19, 2007
Summary
Macrolide antibiotics reduce inflammation in chronic rhinosinusitis (CRS) by down-regulating pro-inflammatory cytokines and inhibiting bacterial virulence. Long-term, low-dose macrolides offer clinical benefits for difficult CRS cases.
Area of Science:
- Immunology
- Pharmacology
- Otolaryngology
Background:
- Antibiotics can modulate immune responses beyond direct antimicrobial action.
- Chronic rhinosinusitis (CRS) involves persistent inflammation and is challenging to manage.
- Macrolide antibiotics possess known anti-inflammatory properties.
Purpose of the Study:
- To review the immunomodulatory effects of macrolides in CRS.
- To propose a treatment algorithm for difficult CRS cases using macrolides.
- To explore macrolide mechanisms in CRS management.
Main Methods:
- In vitro studies assessing cytokine inhibition (e.g., interleukin-8) and NF-kappaB activation.
- In vivo analysis of nasal lavage for cytokine levels and secretions.
- Clinical evaluation of patient-reported outcomes and symptom reduction.
Main Results:
- Macrolides inhibit pro-inflammatory cytokines and NF-kappaB activation, reducing neutrophilic inflammation.
- Inhibition of bacterial virulence and biofilm formation observed.
- Clinical improvements include reduced pain, headache, post-nasal drip, and improved quality of life.
Conclusions:
- Macrolides demonstrate significant immunomodulatory effects beneficial in CRS.
- Long-term, low-dose macrolide therapy is a viable option for difficult-to-treat, non-atopic, bilateral CRS.
- Surgery remains the primary option for unilateral CRS; macrolide resistance is not currently a major clinical concern.
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