2016 Section 5 Green Book

Post-FESS long-term macrolide therapy for NP

TABLE 9. EAS (points)

in group 1 (antibiotics for 24 weeks): 153.6 ± 98.8 ng/mL ( p = 0.028), and in group 2 (antibiotics for 12 weeks): 290.4 ± 77.2 ng/mL ( p = 0.036). ECP level in the nasal discharge in group 3 (control no antibiotics) patients did not change significantly and was recorded as 654.0 ± 184.9 ng/mL ( p = 0.25). Only in group 1 (antibiotics for 24 weeks) did the ECP concentration remain at the same low level (154.8 ± 89.8 ng/mL) at 24 weeks. In group 2 (antibiotics for 12 weeks) there was a slight in- crease of the ECP levels up to 338.1 ± 83.1 ng/mL ( p = 0.084) when these patients were studied at 24 weeks (3 months after stopping the antibiotics); however, with a p value of 0.084, the difference was not statistically significant. The mean ECP level in the nasal discharge in group 3 (control no antibiotics) rose significantly to 1000.0 ± 222.7 ng/mL ( p = 0.041) (Fig. 6, Table 10). It is important to note that the ECP level in patients treated with the macrolides over a full 6 months (group 1) was significantly lower than in those patients in group 2, who stopped the antibiotic therapy after 3 months of treatment. Side effects were uncommon with discontinuation of antibiotic therapy required in only 3 patients. Liver enzymes levels (alanine transaminase [ALT], aspartate

Group 1 (antibiotics 24 weeks)

Group 2 (antibiotics 12 weeks)

Group 3 (control no antibiotic)

Visits

Baseline

12.09 ± 0.96 2.05 ± 0.73 * 1.61 ± 0.62 * 1.52 ± 0.87 *

12.78 ± 0.92 2.00 ± 1.06 * 2.00 ± 1.34 2.42 ± 1.61 *

11.42 ± 1.09 5.00 ± 1.27 4.92 ± 1.66 6.35 ± 1.58

6 weeks

12 weeks

24 weeks

*Significant differences between study and control groups ( p < 0.05). EAS = endoscopic appearances score.

The most remarkable results occurred in the evaluation of ECP concentration postoperatively. Before the surgery, me- dian values of ECP concentrations in all 3 patients groups did not differ significantly, being 412.2 ± 123.1, 279.4 ± 85.9, and 330.8 ± 104.5, respectively. Six weeks after surgery, the ECP level in the nasal discharge increased in all study patients, being 553.2 ± 115.5, 604.0 ± 173.2, and 660.0 ± 171.6 ng/mL in groups 1, 2, and 3, respec- tively. Twelve weeks after FESS, a significant decrease of the ECP level in the nasal discharge was clearly observed

FIGURE 5. Endoscopic appearance and CT scans of 26-year-old male patient (CRSwNP, bronchial asthma, 5 previous sinus surgeries) before and after FESS followed by 6-month course of low-dose clarithromycin therapy. Before FESS: (A) large polyps completely block left nasal cavity; (B, C) total opacification of paranasal sinuses and signs of osteitis on axial and coronal CT scans. Six months after FESS: (D) no visible polyps, multiple synechiae in the left ethmoid cavity; (E, F) sinuses are pneumatized, slight thickening of the ethmoid mucosa. CRSwNP = chronic rhinosinusitis with nasal polyposis; CT = computed tomography; FESS = functional endoscopic sinus surgery.

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