One-year low-dose erythromycin treatment of persistent chronic sinusitis after sinus surgery: clinical outcome and effects on mucociliary parameters and nasal nitric oxide.

Abstract

OBJECTIVE:

In 17 patients with chronic sinusitis persistent after sinus surgery, long-term, low-dose erythromycin therapy was tested. The aim of the investigation was to study the clinical outcome and effects on nasal nitric oxide (NO), ciliary beat frequency (CBF), and mucociliary transport (saccharine transit time).

STUDY DESIGN AND SETTING:

We conducted a prospective open study at a tertiary teaching hospital. Symptoms were assessed using visual analog scales. NO was measured using a chemiluminescence analyzer, and mucociliary transport was measured with the saccharine crystal technique. CBF was measured in nasal brush samples using a phase contrast microscope. All patients were treated with erythromycin succinate 250 mg 2x daily or clarithromycin 250 mg 1x daily and were assessed after 3 months. In cases where there was no response, treatment was abandoned. The remaining patients (responders) were reassessed after 12 months of treatment.

RESULTS:

Of 17 patients, 12 responded to treatment. The 12-month follow-up showed an improvement in saccharine transit time (P < 0.05) but no significant change in CBF. There was a trend toward an increase in NO (P = 0.12). Endoscopic nasal examination scoring improved significantly (P < 0.01). In the visual analog scale scoring, the most pronounced improvements were seen in nasal congestion, sticky secretion, and runny nose at 3 and 12 months (P < 0.01). Improvements were also seen in headache (P < 0.05).

CONCLUSION:

The present study suggests that long-term, low-dose treatment with erythromycin is effective in persistent chronic sinusitis that does not respond to sinus surgery or systemic steroid/antibiotic treatment.

SIGNIFICANCE:

Long-term, low-dose erythromycin therapy seems to be a promising alternative when more conventional therapy fails. However, placebo-controlled studies are needed to validate the potential of this treatment.

• Authors: Anders Cervin, Olof Kalm, Per Sandkull, Sven Lindberg
• Journal: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (Otolaryngol Head Neck Surg) Vol. 126 Issue 5 Pg. 481-9 (May 2002) ISSN: 0194-5998 [Print] England
• PMID: 12075221 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Nitric Oxide
• Erythromycin

Topics

• Adolescent
• Adult
• Aged
• Anti-Bacterial Agents (administration & dosage, therapeutic use)
• Chronic Disease
• Cilia (drug effects, physiology)
• Dose-Response Relationship, Drug
• Erythromycin (administration & dosage, therapeutic use)
• Female
• Humans
• Male
• Middle Aged
• Mucociliary Clearance (drug effects, physiology)
• Nitric Oxide (analysis)
• Outcome Assessment, Health Care
• Prospective Studies
• Recurrence
• Sinusitis (drug therapy, physiopathology, surgery)
• Time Factors
• Treatment Failure