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Updated: Mar 17, 2026
Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
Azithromycin for the treatment of eosinophilic nasal polyposis: Clinical and histologic analysis
Isamara Simas de Oliveira1, Paulo Fernando Tormin Borges Crosara, Geovanni Dantas Cassali
1Post Graduate Program in Surgery and Ophthalmology, Universidade Federal de Minas Gerais [UFMG], Belo Horizonte, Brazil.
Introduction:
Macrolides used as immunomodulators are a promising tool for chronic inflammatory airway diseases. Eosinophilic nasal polyposis (ENP) is still considered a disease that is difficult to control with the currently standardized treatments.
Objectives:
To evaluate prolonged treatment with low-dose azithromycin for ENP based on clinical and histopathologic variables.
Methods:
The present investigation was a self-paired case study of 33 patients with ENP. A comparison was performed between patients before and after treatment with azithromycin for 8 weeks. The patients were subjected to clinical examinations, staging (three-dimensional imaging by endoscopy), application of the questionnaire, and biopsy of nasal polyps at the beginning and at the end of the treatment.
Results:
The treatment yielded a clinical improvement regarding the two variables studied: polyposis staging (69.7%) and questionnaire (57.6%). We did not find significant differences in the inflammatory pattern and in the percentage or absolute number of eosinophils per field between samples obtained before and after the treatment (p > 0.05). There was no difference between the answers obtained from groups with and without asthma and/or aspirin intolerance (p > 0.3). The patients with advanced initial staging exhibited lower subjective improvement index and staging reduction (p = 0.031 and p = 0.012, respectively).
Conclusion:
Based on this study, azithromycin may be considered as another therapeutic option for ENP. However, further studies are necessary to define the real mechanism of action involved.
Insights
Low-dose azithromycin treatment improved clinical outcomes in eosinophilic nasal polyposis (ENP) patients. However, it did not significantly alter histopathologic inflammatory markers, suggesting further research into its mechanism of action is needed.
Area of Science:
- Immunology
- Otolaryngology
- Pharmacology
Background:
- Macrolides show promise as immunomodulators for chronic inflammatory airway diseases.
- Eosinophilic nasal polyposis (ENP) presents challenges in management with current standard treatments.
Purpose of the Study:
- To assess the efficacy of prolonged, low-dose azithromycin in treating ENP.
- To evaluate clinical and histopathologic changes following azithromycin therapy.
Main Methods:
- A self-paired study involving 33 ENP patients treated with azithromycin for 8 weeks.
- Clinical assessments included endoscopy-based staging and patient questionnaires.
- Nasal polyp biopsies were analyzed for histopathologic changes before and after treatment.
Main Results:
- Clinical improvement was observed in 69.7% for polyposis staging and 57.6% via questionnaire.
- No significant changes were found in inflammatory patterns or eosinophil counts (p > 0.05).
- Patients with advanced initial staging showed less improvement.
Conclusions:
- Azithromycin represents a potential therapeutic option for ENP management.
- Further investigation is required to elucidate the precise mechanisms of azithromycin's action in ENP.
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