Pharmacotherapy of Chronic Rhinosinusitis with a Focus on Clarithromycin: An Expert Opinion

Chronic Rhinosinusitis (CRS) is frequently distinguished as persistent symptomatic inflammation of the nasal and sinus mucosa and is recognized as one of the most common chronic diseases, with high incidence rate. It has a major impact on overall quality of life. Although, the etiology and pathogenesis of CRS are not clearly understood, there are several hypotheses on CRS etiology and pathogenesis. The presence of biofilms and bacterial infection, as well as fungal infection, allergy, environmental pollutants, and smoking are considered as a possible environmental factors which are involved in etiology of CRS. Over the past few years, the presence of biofilms is indicated in more than 65% of chronic infections in humans. The most important goals of treatment in CRS include suppression of the infection, reduction of sinonasal inflammation, and maintenance of patent sinonasal passage drainage. CRS is generally treated with medical and surgical therapy. Antibiotics play a major role in the treatment of CRS and are often used to reduce the infectious component of CRS. Macrolide antibiotics are considered as a choice of treatment option as they have anti-inflammatory and immunomodulatory properties in addition to usual antimicrobial effects. Clarithromycin is one of the macrolide which has shown beneficial effects for treating CRS. Various studies indicated that long term use of clarithromycin is effective in the treatment of CRS with good tolerability profile The present review suggests that clarithromycin can be used as treatment of choice in the treatment of CRS.