Faculty of Medicine, Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Faculty of Medicine, Department of Pharmacy and Siriraj Health Policy Unit, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Allergy Clin Immunol Pract. 2017 Nov-Dec;5(6):1632-1638. doi: 10.1016/j.jaip.2017.03.029. Epub 2017 Apr 21.
Recurrent acute rhinosinusitis (RARS) is characterized by multiple episodes of acute rhinosinusitis between which symptoms and signs resolve completely. The role of antibiotic prophylaxis to prevent RARS in children with nonallergic rhinitis (NAR) has not been investigated.
To evaluate the effect of azithromycin to prevent RARS in children with NAR.
A randomized, double-blind, placebo-controlled study was conducted in NAR children (5-15 years) with RARS. Azithromycin (5 mg/kg/d) 3 d/wk for 12 months or placebo was assigned to the study group and the control group, respectively. Patients with allergic rhinitis were excluded. Number of rhinosinusitis episodes in 12 months, visual analog scale score of nasal symptoms, and adjunctive medication score were recorded.
Forty patients were enrolled and 20 patients were assigned randomly to the azithromycin and placebo groups. IgG subclass and specific antibody deficiencies were found in 83% and 2.5% of patients, respectively. After 12 months, the number of rhinosinusitis episodes/y in the azithromycin group reduced significantly from 5 to 0.5 (P < .001) in contrast to the placebo group. Number needed to treat using azithromycin prophylaxis to prevent 1 patient from having RARS was 2. The average visual analog scale score and the average adjunctive medication score in the azithromycin (but not in the placebo) group reduced significantly compared with baseline (2.2 ± 1.4 vs 5.4 ± 1.8) and (3.9 ± 1.7 vs 5.4 ± 1.1), respectively (P < .001).
Azithromycin prophylaxis can reduce the number of rhinosinusitis episodes and medication score, and improve nasal symptoms in NAR children with RARS.
复发性急性鼻-鼻窦炎（RARS）的特征是在完全缓解症状和体征之间发生多次急性鼻-鼻窦炎发作。对于非变应性鼻炎（NAR）患儿，抗生素预防是否可预防 RARS 尚未得到研究。
评估阿奇霉素预防 NAR 患儿 RARS 的效果。
一项随机、双盲、安慰剂对照研究纳入了患有 RARS 的 NAR 儿童（5-15 岁）。阿奇霉素（5mg/kg/d）每周 3 天，共 12 个月或安慰剂分别分配至研究组和对照组。排除变应性鼻炎患儿。记录 12 个月内鼻窦炎发作次数、鼻腔症状视觉模拟量表评分和辅助药物评分。
共纳入 40 例患儿，其中 20 例患儿随机分配至阿奇霉素组和安慰剂组。分别有 83%和 2.5%的患儿存在 IgG 亚类和特异性抗体缺乏。治疗 12 个月后，阿奇霉素组的年鼻窦炎发作次数从 5 次显著减少至 0.5 次（P<0.001），而安慰剂组无显著变化。使用阿奇霉素预防治疗预防 1 例患儿发生 RARS 的需要治疗人数为 2。与基线相比，阿奇霉素组（而非安慰剂组）的平均视觉模拟量表评分和平均辅助药物评分均显著降低（2.2±1.4 比 5.4±1.8 和 3.9±1.7 比 5.4±1.1）（均 P<0.001）。
阿奇霉素预防可减少 NAR 患儿 RARS 的发作次数和药物评分，并改善鼻部症状。
