Efficacy of combined treatment with S-carboxymethylcysteine (carbocisteine) and clarithromycin in chronic rhinosinusitis patients without nasal polyp or with small nasal polyp.

Abstract

OBJECTIVE:

In Japan, fourteen-membered ring macrolides, antibacterial agents, and S-carboxymethylcysteine (SCMC; carbocisteine), a mucolytic, are commonly used to treat chronic rhinosinusitis (CRS), and they are also used in combination. However, no large-scale randomized study has examined the effects of these pharmacotherapies. The aim of this study is to evaluate the effect of combined administration of clarithromycin (CAM), a fourteen-membered ring macrolide, and SCMC, compared with CAM single therapy.

METHODS:

Patients with CRS were centrally registered and randomly assigned to treatment with CAM (200mg/day) alone (monotherapy group) or CAM (200mg/day) in combination with SCMC (1500mg/day; combination group) for 12 weeks. We assessed the clinical efficacy of the treatments using measures of subjective symptoms and objective findings, health-related quality of life (HRQOL) determined by the 20-Item Sino-Nasal Outcome Test (SNOT-20) score and computed tomography (CT) score.

RESULTS:

Four hundred twenty-five subjects were enrolled (combination group, 213; monotherapy group, 212). At week 12 of treatment, the rate of effectiveness was significantly higher in the combination group (64.2%) compared with the monotherapy group (45.6%; P=0.001). In addition, objective findings, including characteristics of nasal discharge (P=0.008) and post-nasal discharge (P=0.002) were significantly improved in the combination group. In both groups, SNOT-20 and CT scores were significantly improved from week 0 (P<0.001), and were not significantly different between groups.

CONCLUSION:

The results indicated that long-term combination therapy with SCMC at a dose of 1500mg/day and CAM at a dose of 200mg/day is effective for improving subjective symptoms and objective findings in adult patients with CRS.

• Authors: Yuichi Majima, Yuichi Kurono, Katsuhiro Hirakawa, Keiichi Ichimura, Shinichi Haruna, Harumi Suzaki, Hideyuki Kawauchi, Kazuhiko Takeuchi, Kensei Naito, Yasuhiro Kase, Tamotsu Harada, Hiroshi Moriyama
• Journal: Auris, nasus, larynx (Auris Nasus Larynx) Vol. 39 Issue 1 Pg. 38-47 (Feb 2012) ISSN: 1879-1476 [Electronic] Netherlands
• PMID: 21636230 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Carbocysteine
• Clarithromycin

Topics

• Adult
• Aged
• Anti-Bacterial Agents (therapeutic use)
• Carbocysteine (therapeutic use)
• Chronic Disease
• Clarithromycin (therapeutic use)
• Drug Therapy, Combination
• Female
• Humans
• Male
• Middle Aged
• Nasal Polyps
• Prospective Studies
• Quality of Life
• Rhinitis (drug therapy)
• Sinusitis (drug therapy)
• Tomography, X-Ray Computed