Efficacy of Long-Term Low-Dose Macrolide Therapy in Preventing Early Recurrence of Nasal Polyps after Endoscopic Sinus Surgery
Long-Term Low-Dose Macrolides and Nasal Polyp Recurrence
DOI:
https://doi.org/10.54393/pjhs.v7i2.3790Keywords:
Nasal Polyps, Endoscopic Sinus Surgery, Macrolides, Lund-KennedyAbstract
Long-term low-dose macrolide therapy has been shown to reduce eosinophilic inflammation and delay early recurrence of nasal polyps following endoscopic sinus surgery (ESS). Objective: To compare the efficacy of long-term low-dose macrolide therapy in preventing early recurrence of nasal polyps after endoscopic sinus surgery. Methods: This randomized controlled trial was conducted in the Department of ENT, Sir Ganga Ram Hospital, Lahore, from October to December 2025. Male and female patients aged 15–75 years diagnosed with nasal polyps and undergoing ESS were included. Patients already receiving antibiotics or macrolides, those with multiple facial fractures, or those with neurological or psychological disorders were excluded. Preoperatively, Sino-Nasal Outcome Test (SNOT), Lund-Kennedy endoscopic score, and Lund-Mackay CT score were recorded. Postoperatively, Group A received clarithromycin 250 mg once daily for three months in addition to standard therapy, while Group B received standard postoperative treatment alone. Outcomes were reassessed at 8 and 12 weeks, and recurrence of nasal polyps was evaluated after three months. Results: Mean SNOT scores showed significant improvement in the macrolide group compared to controls at both 8 and 12 weeks (p<0.05). Similarly, Lund-Mackay and Lund-Kennedy scores demonstrated significantly greater reductions in the macrolide group than in the non-macrolide group (p<0.05). Recurrence of nasal polyps was observed in 12% of patients receiving macrolide therapy compared to 32% in the control group. Conclusions: Three-month low-dose clarithromycin therapy (250 mg/day) is a safe and effective adjunct to ESS, significantly improving clinical, endoscopic, and radiological outcomes while reducing early recurrence of nasal polyps.
References
Chen H, Zhou B, Huang Q, Li C, Wu Y, Huang Z et al. Efficacy and Safety of Long-Term Low-Dose Clarithromycin in Patients with Refractory Chronic Sinusitis After Endoscopic Sinus Surgery: A Prospective Clinical Trial. Ear, Nose, and Throat Journal. 2024 Jan; 103(1): 31-9. doi: 10.1177/01455613211032020. DOI: https://doi.org/10.1177/01455613211032020
Loperfido A, Cavaliere C, Begvarfaj E, Ciofalo A, D’Erme G, De Vincentiis M et al. The Impact of Antibiotics and Steroids on the Nasal Microbiome in Patients with Chronic Rhinosinusitis: A Systematic Review According to Patient/Population, Intervention, Comparison, and Outcome Criteria. Journal of Personalized Medicine. 2023 Nov; 13(11): 1583. doi: 10.3390/jpm13111583. DOI: https://doi.org/10.3390/jpm13111583
Wallwork B, Coman W, Mackay‐Sim A, Greiff L, Cervin A. A Double‐Blind, Randomized, Placebo‐Controlled Trial of Macrolide in the Treatment of Chronic Rhinosinusitis. The Laryngoscope. 2006 Feb; 116(2): 189-193. doi: 10.1097/01.mlg.0000191560.53555.08. DOI: https://doi.org/10.1097/01.mlg.0000191560.53555.08
Bezerra TF, Pezato R, Barros PM, Coutinho LL, Costa LF, Pinna F et al. Prospective Evaluation of Clarithromycin in Recurrent Chronic Rhinosinusitis with Nasal Polyps. Brazilian Journal of Otorhinolaryngology. 2021 Jul; 87(3): 298-304. doi: 10.1016/j.bjorl.2019.09.008. DOI: https://doi.org/10.1016/j.bjorl.2019.09.008
Oakley GM, Harvey RJ, Lund VJ. The role of macrolides in chronic rhinosinusitis (CRSsNP and CRSwNP). Current allergy and asthma reports. 2017 May; 17(5): 30. doi: 10.1007/s11882-017-0696-z. DOI: https://doi.org/10.1007/s11882-017-0696-z
Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU et al. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis 2021. In International Forum of Allergy and Rhinology. 2021 Mar; 11(3):213-739.
Mueller SK, Nocera AL, Dillon ST, Gu X, Wendler O, Otu HH et al. Noninvasive Exosomal Proteomic Biosignatures, Including Cystatin SN, Peroxiredoxin‐5, And Glycoprotein VI, Accurately Predict Chronic Rhinosinusitis with Nasal Polyps. In the International Forum of Allergy and Rhinology. 2019 Feb; 9 (2):177-186. doi: 10.1002/alr.22226. DOI: https://doi.org/10.1002/alr.22226
Perot BQ and Baban MI. The Role of the Macrolide in Preventing Recurrence of the Nasal Polyposis After Fess. Pakistan Journal of Medical & Health Sciences. 2021; 14.
Lim YH, Kim JM, Hwang JY, Kwon TY, Kim YB, Kim SW. Effects of Low-Dose Long-Term Macrolide Therapy on the Postoperative Symptom Change, Mucociliary Clearance, and Polyp Regrowth. Journal of Rhinology. 2002: 47-51.
Kricker JA, Page CP, Gardarsson FR, Baldursson O, Gudjonsson T, Parnham MJ. Nonantimicrobial Actions of Macrolides: Overview and Perspectives for Future Development. Pharmacological Reviews. 2021 Oct; 73(4): 1404-1433. doi: 10.1124/pharmrev.121.000300. DOI: https://doi.org/10.1124/pharmrev.121.000300
Smith D, Du Rand IA, Addy C, Collyns T, Hart S, Mitchelmore P et al. British Thoracic Society Guideline for the use of Long-Term Macrolides in Adults with Respiratory Disease. Biomedical Journal Open Respiratory Research. 2020 Apr; 7(1): 1-6. doi: 10.1136/bmjresp-2019-000489. DOI: https://doi.org/10.1136/bmjresp-2019-000489
Undela K, Goldsmith L, Kew KM, Ferrara G. Macrolides Versus Placebo for Chronic Asthma. Cochrane Database of Systematic Reviews. 2021; 11: 1-97. doi: 10.1002/14651858.CD002997.pub5. DOI: https://doi.org/10.1002/14651858.CD002997.pub5
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020 Feb;58(29): 1-484. doi: 10.4193/Rhin20.601. DOI: https://doi.org/10.4193/Rhin20.601
Ryu G, Lee E, Park SI, Park M, Hong SD, Jung Y et al. The Mechanism of Action and Clinical Efficacy of Low-Dose Long-Term Macrolide Therapy in Chronic Rhinosinusitis. International Journal of Molecular Sciences. 2023 May; 24(11): 9489. doi: 10.3390/ijms24119489. DOI: https://doi.org/10.3390/ijms24119489
Seresirikachorn K, Chetthanon T, Suwansirisuk T, Aeumjaturapat S, Chusakul S, Kanjanaumporn J et al. Low-Dose Macrolides for Treating Pediatric Rhinosinusitis: A Retrospective Study and Literature Review. SAGE Open Medicine. 2020 Jun; 8: 1-7. doi: 10.1177/2050312120933642. DOI: https://doi.org/10.1177/2050312120933642
Wu Y, Shi X, Ni S, Sun H. Efficacy of Clarithromycin Combined with Fluticasone Propionate on Nasal Function, Nasal Mucociliary Transport Function, and Serum Inflammatory Markers in Chronic Rhinosinusitis Patients After Functional Endoscopic Sinus Surgery. Ear, Nose & Throat Journal. 2024 Nov: 117. doi: 10.1177/01455613241294244. DOI: https://doi.org/10.1177/01455613241294244
Lin CF, Wang MC, Merton AT, Ho NH, Wu PS, Hsu AT et al. Add-On Effect of Clarithromycin to Oral Steroids as Post-Operative Therapy for Chronic Rhinosinusitis with Nasal Polyps: A Randomised Controlled Trial. Rhinology. 2020 Dec; 58(6): 550-558.
Seresirikachorn K. Predictive Factors for Identifying Macrolide Responders in Treating Chronic Rhinosinusitis. 2020: 1-69.
Suzaki I. The Role of Macrolides in Chronic Rhinosinusitis and Nasal Polyps. Current Opinion in Allergy and Clinical Immunology. 2025 Feb; 25(1): 19-26. doi: 10.1097/ACI.0000000000001050. DOI: https://doi.org/10.1097/ACI.0000000000001050
Videler WJ, Badia L, Harvey RJ, Gane S, Georgalas C, Van Der Meulen FW et al. Lack of Efficacy of Long‐Term, Low‐Dose Azithromycin in Chronic Rhinosinusitis: A Randomized Controlled Trial. Allergy. 2011 Nov; 66(11): 1457-1468. doi: 10.1111/j.1398-9995.2011.02693.x. DOI: https://doi.org/10.1111/j.1398-9995.2011.02693.x
Zeng M, Wang H, Liao B, Wang H, Long XB, Ma J et al. Clinical and Biological Markers Predict the Efficacy of Glucocorticoid-and Macrolide-Based Postoperative Therapy in Patients with Chronic Rhinosinusitis. American Journal of Rhinology and Allergy. 2021 Sep; 35(5): 596-606. doi: 10.1177/1945892420982236. DOI: https://doi.org/10.1177/1945892420982236
Lourijsen ES, Reitsma S, Vleming M, Hannink G, Adriaensen GF, Cornet ME et al. Endoscopic Sinus Surgery with Medical Therapy Versus Medical Therapy for Chronic Rhinosinusitis with Nasal Polyps: A Multicentre, Randomised, Controlled Trial. The Lancet Respiratory Medicine. 2022 Apr; 10(4): 337-346. doi: 10.1016/S2213-2600(21)00457-4. DOI: https://doi.org/10.1016/S2213-2600(21)00457-4
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