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Nasal polyps macrolide

Andrew J Thomas, Jeremiah A Alt
Oral therapeutics for chronic rhinosinusitis with nasal polyps (CRSwNP) include oral corticosteroids (OCS), antibiotics, antifungals and anti-leukotrienes. Of these treatments, the strongest evidence exists to support the use of a short course of OCS for treatment of CRSwNP, and OCS are the most consistently recommended oral therapy in practice guidelines. Antibiotics have demonstrated some utility, which appears more likely related to an anti-inflammatory rather than antimicrobial effect. The non-macrolide antibiotics lack sufficient evidence to support their use, though among this class doxycycline has some limited evidence of benefit in CRSwNP...
2016: Advances in Oto-rhino-laryngology
Gretchen M Oakley, Richard J Harvey
Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition with heterogeneous pathophysiology. A cornerstone of the management of this condition is the use of anti-inflammatory agents. Corticosteroids are very effective and the most commonly used, but other drugs with immunodulatory activity such as anti-IL5, doxycycline (Th2), and macrolides (anti-neutrophilic/IL8) have been shown to have efficacy. Although systemic corticosteroids have shown benefit in managing this condition, the frequency of use often required in this condition is associated with significant adverse effects...
2016: Advances in Oto-rhino-laryngology
Ashleigh A Halderman, Andrew P Lane
The inflammatory mechanisms that contribute to chronic rhinosinusitis with nasal polyps (CRSwNP) are complex. In the past, medical options for treating CRSwNP have been limited. Emerging classes of immunomodulators such as omalizumab, anti-leukotrienes, anti-IL-4, anti-IL-5, and recognition of the modulating effects of macrolides have shown promising results in the treatment of CRSwNP. Ultimately, large randomized controlled trials are necessary to establish the efficacy of these medications but for now, the area of medical immunomodulators remains an exciting frontier...
2016: Advances in Oto-rhino-laryngology
Isamara Simas de Oliveira, Paulo Fernando Tormin Borges Crosara, Geovanni Dantas Cassali, Diego Carlos Dos Reis, Danilo Santana Rodrigues, Flavio Barbosa Nunes, Roberto Eustáquio Santos Guimarães
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...
January 2016: Allergy & Rhinology
Daniel L Hamilos
Chronic rhinosinusitis (CRS) is highly prevalent in patients with cystic fibrosis (CF) and accounts for significant morbidity and contribution to CF lung disease. Mutations of the cystic fibrosis transmembrane regulator gene occur with increased prevalence in patients with CRS without CF, suggesting some contribution to CRS pathophysiology. Nasal polyps (NPs) occur with increased prevalence in patients with CF of all ages and have a more neutrophilic appearance with fewer eosinophils and increased submucosal glandular elements in comparison to NPs from patients without CF...
July 2016: Journal of Allergy and Clinical Immunology in Practice
Jessica Bewick, Shahzada Ahmed, Sean Carrie, Claire Hopkins, Anshul Sama, Vishnu Sunkaraneni, Jane Woods, Steve Morris, Sally Erskine, Carl Philpott
OBJECTIVES: There is currently conflicting level 1 evidence in the use of long-term antibiotics for chronic rhinosinusitis without nasal polyps. The primary aim of this feasibility study was to optimise future randomised trial design by assessing recruitment and retention of patients alongside providing preliminary data on symptomatic control. DESIGN: Prospective, multi-centre feasibility (cohort) study with all patients receiving macrolide therapy for 12-weeks and a further subsequent 12-week follow-up...
May 25, 2016: Clinical Otolaryngology
Karen Head, Lee Yee Chong, Patorn Piromchai, Claire Hopkins, Carl Philpott, Anne G M Schilder, Martin J Burton
BACKGROUND: This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Systemic and topical antibiotics are used with the aim of eliminating infection in the short term (and some to reduce inflammation in the long term), in order to normalise nasal mucus and improve symptoms...
2016: Cochrane Database of Systematic Reviews
Luke Rudmik, Zachary M Soler
IMPORTANCE: Chronic sinusitis is a common inflammatory condition defined by persistent symptomatic inflammation of the sinonasal cavities lasting longer than 3 months. It accounts for 1% to 2% of total physician encounters and is associated with large health care expenditures. Appropriate use of medical therapies for chronic sinusitis is necessary to optimize patient quality of life (QOL) and daily functioning and minimize the risk of acute inflammatory exacerbations. OBJECTIVE: To summarize the highest-quality evidence on medical therapies for adult chronic sinusitis and provide an evidence-based approach to assist in optimizing patient care...
September 1, 2015: JAMA: the Journal of the American Medical Association
A Perić, N Baletić, M Milojević, J Sotirović, L Živić, A V Perić, D Vojvodić
OBJECTIVE: In recent years, various investigators have shown considerable interest in the use of macrolide antibiotics for treatment of chronic rhinosinusitis and nasal polyposis. The aim of this study was to evaluate the clinical effects of preoperative long-term, low-dose clarithromycin administration in patients with nasal polyposis. METHODS: Eighty nasal polyp patients (42 non-atopic and 38 atopic) were included in this prospective, non-placebo controlled investigation and randomized equally to either the combined clarithromycin-surgical or surgical group...
December 2014: West Indian Medical Journal
Saleh Khaled Aboud, Salina Husain, Balwant Singh Gendeh
BACKGROUND: The aim of this prospective study is to evaluate whether changes in endoscopy score correlate with changes in quality of life (QOL) in nasal polyposis (NP) patients after optimal medical therapy. METHODOLOGY: An interventional clinical trial study involving fifty five patients with grade I and II NP was conducted. Patients were initially treated with a single dose oral prednisolone 25 mg for 2 weeks, Macrolide 250 mg daily for the first 3 months and long-term intranasal steroids...
December 2014: Rhinology
Boris R Haxel, Meike Clemens, Niki Karaiskaki, Uta Dippold, Lisanne Kettern, Wolf J Mann
OBJECTIVES/HYPOTHESIS: The efficacy of macrolides in chronic rhinosinusitis (CRS) is still under controversy. To date, only two double-blind, placebo-controlled studies have been published with differing results. None of these studies investigated the possible benefit of macrolides in the postoperative period. We conducted an investigator-initiated clinical trial using 250-mg erythromycin once a day over a period of 3 months, beginning the administration of either erythromycin or placebo 2 weeks after a surgical intervention for CRS...
May 2015: Laryngoscope
Sisi Li, Jianfu Chen, Yongmei Yu, Biao Ruan, Ling Lu
OBJECTIVE: To evaluate the efficacy of standardized medication for patients with chronic rhinosinusitis. METHOD: According to the diagnosis and treatment guidelines on chronic rhinosinusitis formulated in 2008, by means of prospective study, we studied 54 patients suffering from chronic rhinosinusitis treated with standardized medication including, a combination of local intranasaI corticosteroids, macrolides, mucus discharging agent and nasal irrigation treatment and followed up for 3 months...
January 2014: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Anastasia Varvyanskaya, Andrey Lopatin
BACKGROUND: This study assessed efficacy of clarithromycin "long-term" macrolide therapy as an adjunct to maintenance therapy with nasal corticosteroids to prevent recurrence of nasal polyps (NP) after functional endoscopic sinus surgery (FESS). METHODS: A total of 66 patients with chronic rhinosinusitis and bilateral NP were randomized into 3 study arms, 22 patients in each arm. After FESS, patients in the first and second groups were treated with clarithromycin 250 mg/day for 12 and 24 weeks, respectively, whereas patients in the third group did not receive any clarithromycin...
July 2014: International Forum of Allergy & Rhinology
Hakan Korkmaz, Bülent Ocal, Emel Cadallı Tatar, Ilkan Tatar, Ali Ozdek, Güleser Saylam, Hakan Hamdi Celik
The objective of the study was to reveal if mometasone furoate nasal spray as monotherapy or combined with long-term oral clarithromycin have influence on biofilms in chronic rhinosinusitis with polyps. The study is a randomized controlled trial in a tertiary referral hospital. Thirty-four patients with chronic rhinosinusitis completed the study. In the first group, 19 patients received mometasone furoate nasal spray 200 μg once daily for 8 weeks. In the second group, 15 patients received oral clarithromycin 500 mg twice daily for 2 weeks and continued once daily 250 mg tablet for subsequent 6 weeks, plus mometasone furoate...
October 2014: European Archives of Oto-rhino-laryngology
Anders Cervin, Ben Wallwork
Long-term treatment of airway inflammation/infection with macrolide antibiotics has now been in use for almost 30 years. Whereas the beneficial clinical effect in cystic fibrosis and COPD have been backed up by randomized controlled trials, the evidence from the upper airways is not as strong. We have identified 22 open studies in chronic rhinosinusitis, with and without polyps, but only 2 randomized controlled trials. Of the controlled trials, the one including CRS patients just without polyps, showed a significant effect in sino-nasal outcome test, saccharine transit time, nasal endoscopy, and IL-8 levels in lavage fluid after 12 weeks of roxithromycin, whereas, in the other RCT with a mixed study group of CRS patients with and without polyps, 12 weeks of azithromycin showed no effect compared to placebo...
March 2014: Current Allergy and Asthma Reports
A V Varvianskaia, A S Lopatin
The objective of the present study was to estimate the effectiveness of the long-term treatment with low doses of macrolides for the prevention of early relapses of polypous rhinosinusitis in the postoperative period. A total of 66 patients at the age from 18 to 77 years presenting with the clinical diagnosis of bilateral polypous rhinosinusitis were randomly allocated to 3 groups; fifty five patients completed the study. All the patients underwent endoscopic polysinusotomy. All of them were given basal therapy with mometasone furoate at a daily dose of 400 mcg throughout 6 month postoperative period...
2013: Vestnik Otorinolaringologii
Payman Dabirmoghaddam, Jalal Mehdizadeh Seraj, Shahin Bastaninejad, Ali Meighani, Zahra Mokhtari
Although several treatments have been suggested for nasal polyposis, from medical to surgical, there is no standard guideline for the management of this disease. During recent years increasing attention has been directed toward the effects of macrolide antibiotics on chronic sinusitis and nasal polyposis. In this study,  the efficacy of clarithromycin on severe nasal polyposis were examined. In a Prospective, before - after study, forty patients with severe nasal polyposis received clarithromycin 500 mg twice a day for 8 weeks...
2013: Acta Medica Iranica
Rong-San Jiang, Shang-Heng Wu, Chen-Chen Tsai, Ya-Hsin Li, Kai-Li Liang
BACKGROUND: This study was designed to examine the efficacy of Chinese herbal medicine (CHM) in the treatment of chronic rhinosinusitis (CRS) without nasal polyps. METHODS: Patients with CRS without nasal polyps were enrolled in the study. Before treatment, they were evaluated by the Taiwanese version of the 20-item Sino-Nasal Outcome Test (TWSNOT-20), nasal endoscopy, saccharin test, and bacterial culture. Then, they were randomized to take CHM (Tsang-Erh-San extract granules and Houttuynia extract powder) or erythromycin for 8 weeks...
July 2012: American Journal of Rhinology & Allergy
Zachary M Soler, Samuel L Oyer, Robert C Kern, Brent A Senior, Stilianos E Kountakis, Bradley F Marple, Timothy L Smith
BACKGROUND: Chronic rhinosinusitis (CRS) is characterized by inflammation of the mucosa of the nose and paranasal sinuses. The role of bacterial or fungal infection in CRS is unclear, yet antimicrobials are commonly prescribed for this condition. Published guidelines offer little direction regarding antibiotic strategies for CRS. The purpose of this article is to provide an evidence-based approach to the use of antibacterial and antifungal antibiotics in the management of CRS. METHODS: A systematic review of the literature was performed following recommendations of the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE)...
January 2013: International Forum of Allergy & Rhinology
A Perić, D Vojvodić, S Matković-Jožin
BACKGROUND: Little is known about the effects of macrolides on the cytokines and chemokines that modulate the function of eosinophils in nasal polyposis. METHODS: Twenty-two non-allergic and 18 allergic patients with nasal polyps were administered clarithromycin 500 mg/day (single oral dose) for eight weeks. We measured the nasal secretion levels of the T helper 2 (also known as Th2) cytokines interleukin 4, 5 and 6, the 'regulated on activation, normal T cell expressed and secreted' (also known as RANTES) chemokine, and the eosinophilic cationic protein, before and after treatment...
May 2012: Journal of Laryngology and Otology
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