Low-Dose Macrolides Can Help Patients with Chronic Rhinosinusitis

by Amy E. Hamaker •

What are the prognostic factors that predict favorable outcomes of low-dose macrolides (LDMs) in treating chronic rhinosinusitis (CRS)?

Bottom Line: LDMs provided favorable outcomes in patients with CRS with nasal polyps (CRSwNP). A half-dose of macrolides should be given for a duration of 24 weeks.

Background: CRSwNP and CRS without nasal polyps (CRSsNP) represent multiple overlapping entities with various inflammatory patterns; patients may be classified into 10 clusters by characteristic cytokines. Currently, long-term LDM therapy in CRS management is controversial—although recommended by international guidelines, LDM therapy supporting evidence is mixed.

Study design: Literature review of 10 randomized controlled trials (608 patients).

Synopsis: Meta-analysis revealed no difference between LDMs and placebo in improvement in Sino-Nasal Outcome Test (SNOT), symptom, and endoscopy scores. There was no trial assessing CT score improvement. There was no difference between the LDMs plus standard treatment and standard treatment in improvement in SNOT, symptom, endoscopy, and CT scores. There was no difference between LDMs and intranasal steroid spray in symptom and endoscopy score improvement; SNOT and CT scores were not assessed. Effects favored LDMs over placebo in SNOT and symptom score improvement in the CRSsNP group, but not in the CRSwNP group. LDMs brought greater SNOT, symptom, and endoscopy improvement compared with placebo for patients without ESS. By macrolides dose, effects and symptom score improvement favored patients receiving a half-dose over those receiving less than a half-dose. SNOT improvements were similar between patients receiving 14- and 15-membered lactone rings of LDMs. SNOT, symptom, and endoscopy improvements favored patients receiving 24-week LDMs over those receiving 12- and eight-week LDMs. LDMs produced greater gastrointestinal adverse effects when compared to other treatments.

Citation: Seresirikachorn K, Suwanparin N, Srisunthornphanich C, et al. Factors of success of low-dose macrolides in chronic sinusitis: systematic review and meta-analysis. Laryngoscope. 2019;129:1510-1519