Articles

The Efficacy of Clarithromycin in Patients with Severe Nasal Polyposis

Abstract

Although several treatments have been suggested for nasal polyposis, from medical to surgical, there is no standard guideline for the management of this disease. During recent years increasing attention has been directed toward the effects of macrolide antibiotics on chronic sinusitis and nasal polyposis. In this study,  the efficacy of clarithromycin on severe nasal polyposis were examined. In a Prospective, before - after study, forty patients with severe nasal polyposis received clarithromycin 500 mg twice a day for 8 weeks. At the beginning and end of treatment, the severity of patients' symptoms (using subjective analogue scale), computed tomography (CT) scan and endoscopic findings were recorded. After treatment, the severity of nasal obstruction, smelling problems, Post Nasal Discharge and rhinorrhea decreased significantly (P<0.05). Furthermore, the degree of sinus opacification in CT scan and endoscopic findings showed significant improvement. Most patients completed their treatment course without significant side effects. Although a course of clarithromycin improved nasal symptoms, polyp size and CT findings, further studies with more patients are required to recommend this drug as a general treatment in nasal polyposis.

Holmström M, Holmberg K, Lundblad L, Norlander T, Stierna P. Current perspectives on the treatment of nasal polyposis: a Swedish opinion report. Acta Otolaryngol 2002;122(7):736-44.

Fokkens W, Lund V, Mullol J; European Position Paper on Rhinosinusitis and Nasal Polyps Group. EP3OS 2007: European Position Paper on Rhinosinusitis and Nasal Polyps 2007. A summary for otorhinolaryngologists. Rhinology 2007;45(2):97-101.

Bachert C, Watelet JB, Gevaert P, VanCauwenberge P. Pharmacological management of nasal polyposis. Drugs 2005;65(11):1537-52.

Tuncer U, Soylu L, Aydogan B, Karakus F, Akcali C . The effectiveness of steroid treatment in nasal polyposis. AurisNasus Larynx 2003;30(3):263-8.

Fowler PD, Gazis AG, Page SR, Jones NS. A randomized double-blind study to compare the effects of nasal fluticasone and betamethasone on the hypothalamopituitary- adrenal axis and bone turnover in patients with nasal polyposis. Clin Otolaryngol Allied Sci 2002;27(6):489-93.

PawankarR. Nasal polyposis: an update.CurrOpin Allergy Clin Immunol 2003;3(1):1-6.

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. Laryngoscope 2006;116(2):189-93.

Ichimura K, Shimazaki Y, Ishibashi T, Higo R.Effect of new macrolide roxithromycin upon nasal polyps associatedwith chronic sinusitis. Auris Nasus Larynx 1996;23:48-56.

Yamada T, Fujieda S, Mori S, Yamamoto H, Saito H.Macrolide treatment decreased the size of nasal polyps and IL-8 levels in nasal lavage. Am J Rhinol 2000;14(3):143-8.

Toros SZ, Bölükbasi S, Naiboğlu B, Er B, Akkaynak C, Noshari H, Egeli E. Comparative outcomes of endoscopic sinus surgery in patients with chronic sinusitis and nasal polyps. Eur Arch Otorhino laryngol 2007;264(9):1003–8.

Johansson L, Akerlund A, Holmberg K, Melén I, Stierna P, Bende M. Evaluation of methods for endoscopic staging of nasal polyposis. Acta Otolaryngol 2000;120(1):72–6.

Hopkins C, Browne JP, Slack R, Lund V, Brown P .The Lund-Mackay staging system for chronic rhinosinusitis: How is it used and what does it predict? Otolaryngol Head Neck Surg 2007;137(4):555-61.

MacLeod CM, Hamid QA, Cameron L, Tremblay C, Brisco W .Anti-inflammatory activity of clarithromycin in adults with chronically inflamed sinus mucosa. Adv Ther2001;18(2):75–82.

Keicho N, KudohS. Diffuse panbronchiolitis: role of macrolides in therapy. Am J Respir Med 2002;1(2):119-31.

Ikeda K, Wu D, TakasakaT. Inhibition of acetylcholineevoked Cl- currents by 14-membered macrolide antibiotics in isolated acinar cells of the guinea pig nasal gland. Am J Respir Cell MolBiol 1995;13(4):449-54.

Matsune S, Sun D, Ohori J, Nishimoto K, Fukuiwa T, Ushikai M, Kurono Y. Inhibition of vascular endothelial growth factor by macrolides in cultured fibroblasts from nasal polyps. Laryngoscope 2005;115(11):1953-6.

Asano K, Kamakazu K, Hisamitsu T, Suzaki H. Suppressive activity of macrolide antibiotics on nitric oxide production from nasal polyp fibroblasts in vitro. Acta Otolaryngol 2003;123(9):1064-69.

Bachert C, Gevaert P, van CauwenbergeP.Staphylococcus aureus enterotoxins: a key in airway disease? Allergy 2002;57(6):480-7.

Morley AD, Sharp HR. A review of sinonasal outcome scoring systems- which isbest? Clin Otolaryngol 2006;31(2):103–9.

20-Benítez P, Alobid I, de Haro J, Berenguer J, Bernal- Sprekelsen M, Pujols L, Picado C, Mullol J. A short course of oral prednisone followed by intranasal budesonide is an effective treatment of severe nasal polyps. Laryngoscope 2006;116(5):770-5.

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IssueVol 51, No 6 (2013) QRcode
SectionArticles
Keywords
Clarithromycin Nasal polyposis Sinusitis Endoscopy

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How to Cite
1.
Dabirmoghaddam P, Mehdizadeh Seraj J, Bastaninejad S, Meighani A, Mokhtari Z. The Efficacy of Clarithromycin in Patients with Severe Nasal Polyposis. Acta Med Iran. 1;51(6):359-364.