Seresirikachorn Kachorn, Chetthanon Thad, Suwansirisuk Teerapat, Aeumjaturapat Songklot, Chusakul Supinda, Kanjanaumporn Jesada, Snidvongs Kornkiat
Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
SAGE Open Med. 2020 Jun 30;8:2050312120933642. doi: 10.1177/2050312120933642. eCollection 2020.
The effects of low-dose macrolide (LDM) therapy on pediatric chronic rhinosinusitis (CRS) patients are unknown. This study aimed to assess the effectiveness of LDM for treating pediatric refractory CRS. A retrospective study was conducted by a medical chart review. Pediatric CRS patients (age <15 years) who received LDM after standard medical treatments failure between 2013 and 2019 were identified. The LDM treatments with any macrolide agents, doses, and regimens were included. Any co-interventions were allowed. Duration of the LDM therapy was ≥6 weeks. Outcomes were the total nasal symptoms by the visual analogue scale (TNS), presence of individual symptoms, physician-assessment nasal discharge and adverse events. Six patients (67% male, mean age 7±3.4 years) were assessed. All patients had failed to intranasal steroids and nasal saline irrigation but continued. The addition of LDM significantly improved TNS (mean difference ± standard deviation 5.83 ± 1.33; 95% confidence interval 4.44-7.23, p< 0.001). At the end of treatment, the numbers of patients with individual symptoms were decreased: nasal obstruction (100%-67%), rhinorrhea (83%-50%), hyposmia (50%-0%), cough (100%-33%), and physician-assessment thick mucoid discharge (33%-0%). No patients had facial pain. One patient reported mild tolerable nausea. Preliminary findings of this study showed some beneficial effects of LDM added to intranasal steroids and nasal saline irrigation in pediatric CRS after standard treatments failure. The beneficial effects included the improvements of the TNS and individual nasal symptoms and decrease in thick mucoid discharge.
低剂量大环内酯类药物（LDM）疗法对小儿慢性鼻-鼻窦炎（CRS）患者的影响尚不清楚。本研究旨在评估LDM治疗小儿难治性CRS的有效性。通过病历回顾进行了一项回顾性研究。确定了2013年至2019年间在标准药物治疗失败后接受LDM治疗的小儿CRS患者（年龄<15岁）。纳入了使用任何大环内酯类药物、剂量和治疗方案的LDM治疗。允许进行任何联合干预。LDM治疗持续时间≥6周。观察指标包括视觉模拟量表评估的总鼻症状（TNS）、个体症状的存在情况、医生评估的鼻分泌物以及不良事件。对6例患者（67%为男性，平均年龄7±3.4岁）进行了评估。所有患者鼻内使用类固醇和鼻腔生理盐水冲洗均失败，但仍继续使用。添加LDM后TNS显著改善（平均差值±标准差5.83±1.33；95%置信区间4.44 - 7.23，p<0.001）。治疗结束时，有个体症状的患者数量减少：鼻塞（100% - 67%）、流涕（83% - 50%）、嗅觉减退（50% - 0%）、咳嗽（100% - 33%）以及医生评估的浓稠黏液性分泌物（33% - 0%）。没有患者出现面部疼痛。1例患者报告有轻度可耐受的恶心。本研究的初步结果显示，在标准治疗失败后的小儿CRS中，LDM联合鼻内类固醇和鼻腔生理盐水冲洗有一些有益效果。有益效果包括TNS和个体鼻症状的改善以及浓稠黏液性分泌物的减少。
