Low-dose macrolides for treating pediatric rhinosinusitis: A retrospective study and literature review

Area of Science:

• Otolaryngology
• Pediatric Pulmonology
• Pharmacology

Background:

• Pediatric chronic rhinosinusitis (CRS) poses a significant clinical challenge.
• The efficacy of low-dose macrolide (LDM) therapy in refractory pediatric CRS remains largely uncharacterized.
• Standard treatments like intranasal steroids and saline irrigation are often insufficient for some children.

Purpose of the Study:

• To evaluate the effectiveness of LDM therapy as an add-on treatment for pediatric patients with refractory CRS.
• To assess the impact of LDM on overall nasal symptom burden and specific clinical indicators.

Main Methods:

• A retrospective chart review of pediatric CRS patients (<15 years) treated with LDM for at least six weeks after standard therapy failure.
• Inclusion of various macrolide agents, doses, and regimens, with co-interventions permitted.
• Outcomes measured included Total Nasal Symptoms (TNS) via visual analogue scale, individual symptom prevalence, physician-assessed nasal discharge, and adverse events.

Main Results:

• Six pediatric patients (mean age 7±3.4 years, 67% male) were analyzed.
• LDM therapy significantly improved TNS (mean difference 5.83 ± 1.33, p<0.001).
• Notable symptom improvements included decreased nasal obstruction, rhinorrhea, hyposmia, cough, and thick mucoid discharge. No facial pain reported; one patient experienced mild nausea.

Conclusions:

• Low-dose macrolide therapy appears beneficial when added to standard care for pediatric refractory CRS.
• LDM therapy can lead to significant improvements in total and individual nasal symptoms.
• Further prospective studies are warranted to confirm these preliminary findings and optimize LDM treatment protocols.