xRead - Nasal Obstruction (September 2024) Full Articles

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was gastrointestinal upset in 8% of patients. Based on this objective CT data the authors concluded that a longer course of therapy is safe and may be indicated to achieve radiographic improvement and disease resolution. Given the limitations of the study, however, they could not deter mine causation for the improvement in LM scores and therefore did not recommend prolonged antibiotics as a rule. As of now there is only 1 study in the literature regard ing this cohort and only 38% of the patient population in that study showing improvement with extended treat ment duration. Lack of rigorous evidence therefore limits any recommendation of non-macrolide oral antibiotics for longer than 3 weeks in standard treatment of CRSsNP.

TABLE IX-29 Evidence for CRSsNP management with oral non-macrolide antibiotics for < 3weeks Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Liu 1090 2018 4 Retrospective cohort Oral antibiotics Oral steroids Combination Lund-Mackay score Symptoms Rate of surgery Improvement in CT scores in all groups

Oral Non-Macrolide Antibiotics for > 3Weeks forCRSNP Aggregate Grade of Evidence: Not applicable (Table IX-30).

IX.D.4.c. Antibiotics for CRSsNP: Macrolide Antibiotics The presumed effects macrolides have on CRS are in reduc ing mucus production, inhibiting biofilm formation, pro ducing oxidative species, inhibiting neutrophils, enhanc ing MCC, and lowering cytokine production. 1109 In 2006, Wallwork et al. 1110 conducted an RCT on CRSsNP patients treated with roxithromycin for 3 months or with placebo. They found significant improvements in SNOT-20, nasal endoscopy, saccharine transit time, and IL-8 levels in lavage fluid. In contrast, Videler et al. 1111 published an RCT in 2011 evaluating the efficacy of azithromycin for recalcitrant CRS both with and with out nasal polyps and found no significant benefit of long term azithromycin over placebo in either QoL outcomes, endoscopy, peak nasal inspiratory flow, Sniffin’ Sticks smell tests, or middle meatus culture. Zengetal. 1072 compared the efficacy of clarithromycin vs mometasone furoate in CRSsNP patients. After 4 weeks of therapy, they found improvements in symptoms and endo scopic findings were comparable across both groups. In an RCT, Jiang et al. 1112 compared the efficacy of erythromycin vs Chinese herbal medicine in the treatment of CRSsNP, demonstrating both groups had a significant but compara ble decrease in SNOT-20 scores after 8 weeks of treatment. Majima et al. 1113 examined the effects of clarithromycin in patients with CRSsNP or those with limited polyps in a cohort study and reported significant improvements in SNOT-20 and computed tomography scores. In comparing