Sireci F, Speciale R, Gallina S, Sorrentino R, Canevari F R
1Otorhinolaryngology Section, Department of Experimental Biomedicine and Clinical Neurosciences, (BioNeC), University of Palermo, via del Vespro 129, 90127 Palermo, Italy.
Otorinolaryngology Section, SS Antonio Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
Indian J Otolaryngol Head Neck Surg. 2018 Mar;70(1):87-91. doi: 10.1007/s12070-017-1153-y. Epub 2017 Jul 20.
The aim of this study is to evaluate the efficacy and safety of prolonged therapy with low-dose clarithromycin in patients with chronic rhinosinusitis with polyps (CRSwP) after endoscopic sinus surgery (ESS). A total of 10 patients with CRSwP were identified and subjected to bilateral ESS. In post-operative patients they were treated with nasal wash with saline solution and steroid sprays (beclomethasone). During follow-up, after 30-40 days after the operation (M = 35.4 SD = +4.33), patients reported a worsening of symptoms with onset of nasal obstruction; reduction/loss of smell; headache; onset of viscous secretions and therefore all patients continued therapy with saline nasal irrigation, topical steroid therapy and started macrolide (clarithromycin 500 mg/pill: 1 pill/day for 3 days a week for 1 month). 22-item SinoNasal Outcome Test (SNOT-22) and a score to the endoscopic evaluation (endoscopic appearance score, EAS) before and after treatment were performed to evaluate efficacy of treatment. The results of the SNOT-22 and EAS showed statistically significant improvements ( < 0.05) for some parameters such as: the need to blow nose, sneezing, hyposmia, viscous mucous secretions about the SNOT-22 and reduction of secretions and edema of the nasal mucosa about the EAS. The preliminary results of our study show that the low-dose clarithromycin for a period of 1 month can improve patient complaints with CRSwP not only through the antibacterial properties but also for the immunomodulatory characteristics.
本研究的目的是评估低剂量克拉霉素长期治疗对慢性鼻窦炎伴鼻息肉（CRSwP）患者行鼻内镜鼻窦手术（ESS）后的疗效和安全性。共确定了10例CRSwP患者并对其进行双侧ESS。术后患者用盐溶液鼻腔冲洗和类固醇喷雾剂（倍氯米松）治疗。在随访期间，术后30 - 40天（M = 35.4，SD = +4.33），患者报告症状恶化，出现鼻塞；嗅觉减退/丧失；头痛；出现粘性分泌物，因此所有患者继续进行盐水鼻腔冲洗、局部类固醇治疗，并开始服用大环内酯类药物（克拉霉素500毫克/片：每周3天，每天1片，共1个月）。在治疗前后进行22项鼻鼻窦结局测试（SNOT - 22）和内镜评估评分（内镜外观评分，EAS）以评估治疗效果。SNOT - 22和EAS的结果显示，一些参数有统计学意义的改善（<0.05），如：SNOT - 22方面的擤鼻需求、打喷嚏、嗅觉减退、粘性粘液分泌物，以及EAS方面的鼻黏膜分泌物和水肿减少。我们研究的初步结果表明，为期1个月的低剂量克拉霉素不仅可以通过抗菌特性，还可以通过免疫调节特性改善CRSwP患者的症状。
