Sireci et al (2018) evaluated the efficacy and safety of prolonged therapy with low-dose clarithromycin in patients with chronic rhinosinusitis with polyps (CRSwP) after endoscopic sinus surgery.

Low-dose clarithromycin for a period of one month can improve patients with eosinophilic chronic rhinosinusitis disorders

A total of 10 patients with CRSwP were identified and subjected to bilateral ESS. In post-operative patients they were treated with nasal wash with saline solution and steroid sprays. During follow-up, after 30-40 days after the operation, patients reported a worsening of symptoms with onset of nasal obstruction; reduction/loss of smell; headache; onset of viscous secretions and therefore all patients continued therapy with saline nasal irrigation, topical steroid therapy and started macrolide (clarithromycin 500mg/pill: 1 pill/day for three days a week for one month). 22-item SinoNasal Outcome Test (SNOT-22) and a score to the endoscopic evaluation (endoscopic appearance score, EAS) before and after treatment were performed to evaluate efficacy of treatment.  

The results of the SNOT-22 and EAS showed statistically significant improvements (p < 0.05) for some parameters such as: The need to blow nose, sneezing, hyposmia, viscous mucous secretions about the SNOT-22 and reduction of secretions and oedema of the nasal mucosa about the EAS. The preliminary results of the study show that the low-dose clarithromycin for a period of one month can improve patient complaints with CRSwP not only through the antibacterial properties but also for the immunomodulatory characteristics. 

This suggests that prolonged treatment with low-dose claritromycin is effective when reserved for patients with recalcitrant CRS linked with BA and/or AERD and/or atopy in whom ESS associated with topical steroid therapy and nasal irrigation is not sufficient. 

CONCLUSION 

The preliminary results of the study show that the low-dose clarithromycin; for a period of one month; can improve patients with eosinophilic chronic rhinosinusitis disorders; not only through the antibacterial properties but also for the immunomodulatory characteristics. 

Using case-control double-blind study and large size of cases; the efficacy of long term macrolide use in the prevention of nasal polyposis recurrence after ESS needs to be determined and a treatment protocol has to be validated internationally for wider usage. 

REFERENCES:  

Sireci F, Speciale R, Gallina S, et al. Clarithromycin in the Management of Chronic Rhinosinusitis: Preliminary Results of a Possible Its New Use. Indian J Otolaryngol Head Neck Surg. 2018;70:87-91. doi:10.1007/s12070-017-1153-y.