Gretchen M Oakley1, Richard J Harvey2,3, Valerie J Lund4. 1. Division of Otolaryngology-Head and Neck Surgery, University of Utah, 50 N. Medical Dr., 3C120, Salt Lake City, UT, 84132, USA. gretchen.oakley@hsc.utah.edu. 2. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia. 3. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. 4. Royal National Throat, Nose and Ear Hospital, London, UK.
Abstract
PURPOSE OF REVIEW: We assess the literature on the pharmacokinetics, indications, important considerations, and effectiveness of long-term, low-dose macrolide antibiotics in chronic rhinosinusitis (CRS). RECENT FINDINGS: The key to effective implementation of macrolide therapy in CRS is appropriate patient selection. Macrolides have demonstrated the most benefit in Th1-mediated non-eosinophilic CRS when used for durations of at least 3 months. Macrolide antibiotics have demonstrated great benefit when used for their anti-inflammatory or immunomodulatory properties, which include the blockage of pro-inflammatory cytokines, such as interleukin (IL)-8 and tumor necrosis factor-α (TNF-α). They have been used in CRS patients not responding to traditional corticosteroid-based treatment regimens, but appear to be most effective specifically in Th1-mediated non-eosinophilic CRS in long durations and low doses. Further research is needed to better identify characteristics known to correlate with macrolide response so early directed therapy can be implemented.
PURPOSE OF REVIEW: We assess the literature on the pharmacokinetics, indications, important considerations, and effectiveness of long-term, low-dose macrolide antibiotics in chronic rhinosinusitis (CRS). RECENT FINDINGS: The key to effective implementation of macrolide therapy in CRS is appropriate patient selection. Macrolides have demonstrated the most benefit in Th1-mediated non-eosinophilic CRS when used for durations of at least 3 months. Macrolide antibiotics have demonstrated great benefit when used for their anti-inflammatory or immunomodulatory properties, which include the blockage of pro-inflammatory cytokines, such as interleukin (IL)-8 and tumor necrosis factor-α (TNF-α). They have been used in CRS patients not responding to traditional corticosteroid-based treatment regimens, but appear to be most effective specifically in Th1-mediated non-eosinophilic CRS in long durations and low doses. Further research is needed to better identify characteristics known to correlate with macrolide response so early directed therapy can be implemented.
Entities:
Keywords:
Chronic rhinosinusitis; Macrolide; Medical management; Non-eosinophilic; Sinusitis
Authors: Annie F Fang; James N Palmer; Alexander G Chiu; Jeffrey L Blumer; Penelope H Crownover; Michael D Campbell; Bharat D Damle Journal: Int J Antimicrob Agents Date: 2009-07 Impact factor: 5.283
Authors: Dong-Jin Lim; Daniel Skinner; John Mclemore; Nick Rivers; Jeffrey Brent Elder; Mark Allen; Connor Koch; John West; Shaoyan Zhang; Harrison M Thompson; Justin P McCormick; Jessica W Grayson; Do-Yeon Cho; Bradford A Woodworth Journal: Int Forum Allergy Rhinol Date: 2019-11-06 Impact factor: 3.858
Authors: Robert J Taylor; Rodney J Schlosser; Zachary M Soler; Jose L Mattos; Jennifer K Mulligan Journal: Int Forum Allergy Rhinol Date: 2018-05-02 Impact factor: 3.858
Authors: Atsushi Kato; Anju T Peters; Whitney W Stevens; Robert P Schleimer; Bruce K Tan; Robert C Kern Journal: Allergy Date: 2021-09-15 Impact factor: 14.710
Authors: Helen Blackshaw; Jane Vennik; Carl Philpott; Mike Thomas; Caroline Eyles; James Carpenter; Caroline S Clarke; Steve Morris; Anne Schilder; Valerie Lund; Paul Little; Stephen Durham; Spiros Denaxas; Elizabeth Williamson; David Beard; Jonathan Cook; Steffi Le Conte; Kim Airey; Jim Boardman; Claire Hopkins Journal: Trials Date: 2019-04-23 Impact factor: 2.279
Authors: Gwanghui Ryu; Jun Sang Bae; Ji Hye Kim; Eun Hee Kim; Lele Lyu; Young Jun Chung; Ji Hun Mo Journal: Allergy Asthma Immunol Res Date: 2020-05 Impact factor: 5.764
Authors: Katie Lloyd; Stamatia Papoutsopoulou; Emily Smith; Philip Stegmaier; Francois Bergey; Lorna Morris; Madeleine Kittner; Hazel England; Dave Spiller; Mike H R White; Carrie A Duckworth; Barry J Campbell; Vladimir Poroikov; Vitor A P Martins Dos Santos; Alexander Kel; Werner Muller; D Mark Pritchard; Chris Probert; Michael D Burkitt Journal: Dis Model Mech Date: 2020-11-27 Impact factor: 5.758