Long-term macrolide therapy was first reported in Japan to be effective for treatment of pulmonary peribronchiolitis and later to be effective for CRS. The effect appears to involve antiinflammatory mechanisms independent of antimicrobial effects, including reducing the production of IL-5, IL-8, and granulocyte-macrophage colony-stimulating factor and decreasing
neutrophil inflammation. Uncontrolled studies have shown improvements in outcome measures for adult patients with CRS. Cervin and associates, monitoring 17 patients treated with erythromycin or clarithromycin for 3 months, found that a majority improved as measured by VAS for congestion and rhinorrhea symptoms. These researchers also measured improvements in saccharin transport time but not ciliary beat frequency. Ragab and colleagues
showed equal improvements as assessed by VAS, SNOT-22, and the 36-item.
Study Short Form in a cohort of adults with CRS randomly assigned to either endoscopic sinus surgery or 3 months of erythromycin therapy.
Wallwork and associates reported in 2006 on the results of a double-blind, randomized placebo-controlled study in which 64 adult patients with CRS received either roxithromycin therapy or placebo for 3 months. The researchers found significant improvements in the treatment group for SNOT-20 and nasal endoscopy scores, saccharin transit time, and IL-8
levels. In a 2007 overview of studies of long-term macrolide therapy for CRS, Cervin and Wallwork concluded that macrolides can possibly also decrease biofilm formation and overall bacterial virulence. Those workers recommended macrolide administration as part of primary therapy in nonatopic patients with bilateral disease.
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