What Is the Role of Long-Term Macrolide Therapy in the Treatment of Recalcitrant Chronic Rhinosinusitis?

Background

Long-duration therapy with macrolide antibiotics has been advocated for the treatment of recalcitrant chronic rhinosinusitis (CRS). The rationale for this treatment is based on the unique anti-inflammatory properties of macrolides rather than a strict antibacterial effect. However, uncertainty exists as to which patients will respond to such treatment, the degree of benefit likely to be obtained and the relevant risks to the patient and community at large.

Best Practice

Low-dose, long-duration macrolide therapy is a viable option for patients with CRS refractory to standard medical and surgical therapies. Based on the limited evidence available, daily clarithromycin (250 mg), azithromycin (250 mg) or roxithromycin (150 mg) should be continued for at least 12 weeks to achieve measurable results. Patients should be selected carefully, as those with atopy and eosinophilic inflammation are unlikely to respond. Patients should understand that improvements are likely to be modest, and symptoms will likely not be fully controlled. At this point in time, further studies are needed to determine whether treatment longer than 12 weeks is beneficial. Similarly, future studies are needed to document the long-term outcomes after cessation of therapy. Available evidence suggests that low-dose macrolide therapy is safe for the individual patient, but clinicians should remain cognizant of the potential for bacterial resistance in the population at large. Read the full article in The Laryngoscope.