2016 Section 5 Green Book

Post-FESS long-term macrolide therapy for NP

the standard of care in the United Sates and some other Western countries, especially in the setting of postoperative eosinophilic inflammation flare-up. However, in countries such as Russia where systemic corticosteroid therapy in CRSwNP is extremely uncommon, long-term macrolides therapy might be an alternative option because it carries less risk of systemic side effects. We did not find an increase in macrolide resistant bacte- rial cultures from the middle meatus after a long-term, low- dose course 250 mg/day of clarithromycin therapy, agreeing with previous studies that also failed to find resistant mi- croorganisms after long-term treatment with azithromycin and erythromycin. 17,20 Of course, the risk of developing antibiotic-resistant strains of bacteria induced by the long- term macrolide therapy is always possible. Although a placebo arm was not designed into our pro- tocol and patients were not blinded when receiving addi- tional therapy, we evaluated 6 different objective methods in all 3 study groups. All investigators were blinded when evaluating and grading the results of nasal endoscopy, CT scans, and all other tests. A future randomized double-blind placebo-controlled study, with a large sample size, would be required to determine the efficacy of long-termmacrolide therapy, particularly in preventing the recurrence of nasal

polyps after FESS. In addition, such a study could hopefully predict which CRSwNP patients would benefit from long- term antibiotic treatment and if this treatment increases the risk of inducing significant bacterial resistance. Conclusion Results of this study demonstrated the efficacy and rela- tive safety of long-term (6 months) low-dose (250 mg/day) macrolide (clarithromycin) therapy for preventing early re- currence of nasal polyps in patients with CRSwNP after FESS. Despite limited clinical data, our evidence suggests that patients with recurrent CRSwNP (surgical failures) de- serve a trial of low-dose clarithromycin treatment (250 mg daily for 3-6 months), which may be initiated immediately after FESS along with maintenance therapy using topical nasal steroids. Acknowledgments We thank Prof. Kirill Zykov and his team (Laboratory for Immunopathology of Cardiovascular Diseases, Cardiology Research Center) for invaluable help with ECP measuring and competent scientific interpretation of the study results.

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