College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, People's Republic of China.
Graduate School, Liaoning University of Traditional Chinese Medicine, Shenyang, People's Republic of China.
Otolaryngol Head Neck Surg. 2023 Dec;169(6):1424-1435. doi: 10.1002/ohn.461. Epub 2023 Aug 7.
To evaluate the efficacy and safety of macrolide antibiotics therapy in patients with chronic rhinosinusitis (CRS) receiving endoscopic sinus surgery.
PubMed, Web of Science, Embase, and Cochrane Library.
The electronic databases were comprehensively searched on June 2, 2022, for randomized controlled trials on macrolide antibiotics in the treatment of patients undergoing CRS endoscopic surgery. The primary outcome measures were the sinonasal outcome test (SNOT) score and the visual analog scale (VAS) score. The secondary outcome measures were the nasal endoscopy score (NES), the sinus computed tomography score, and adverse events.
A total of 8 studies were included, involving 606 patients who used macrolide for a long time. Meta-analysis showed that no significant difference was observed in SNOT (standardized mean difference [SMD] = -0.13; 95% confidence interval [CI]: -0.38 to 0.13, I = 0%) and VAS (SMD = -0.10; 95% CI, -0.88 to 0.68, I = 81%) between the macrolide and placebo groups. However, macrolide outperformed the placebo in improving NES (SMD = -0.32; 95% CI, -0.62 to -0.03, I = 21%). The use of macrolide did not increase the incidence of adverse events.
Long-term use of macrolide after CRS surgery may not significantly improve the quality of life and disease severity of the patients but may play a role in improving postoperative NES in patients with CRS. There is still no sufficient evidence to determine whether the disease phenotype of CRS or the patient's race will affect the efficacy of long-term use of macrolide after CRS.
评估大环内酯类抗生素治疗慢性鼻-鼻窦炎（CRS）患者内镜鼻窦手术后的疗效和安全性。
PubMed、Web of Science、Embase 和 Cochrane Library。
2022 年 6 月 2 日全面检索了电子数据库中关于大环内酯类抗生素治疗接受 CRS 内镜手术患者的随机对照试验。主要结局指标为鼻-鼻窦结局测试（SNOT）评分和视觉模拟评分（VAS）。次要结局指标为鼻内镜评分（NES）、鼻窦计算机断层扫描评分和不良事件。
共纳入 8 项研究，涉及 606 例长期使用大环内酯类药物的患者。Meta 分析显示，大环内酯类药物组与安慰剂组在 SNOT（标准化均数差 [SMD] = -0.13；95%置信区间 [CI]：-0.38 至 0.13，I² = 0%）和 VAS（SMD = -0.10；95%CI：-0.88 至 0.68，I² = 81%）方面无显著差异。然而，大环内酯类药物在改善 NES（SMD = -0.32；95%CI：-0.62 至 -0.03，I² = 21%）方面优于安慰剂。大环内酯类药物的使用并未增加不良事件的发生率。
CRS 手术后长期使用大环内酯类药物可能不会显著改善患者的生活质量和疾病严重程度，但可能在改善 CRS 患者术后 NES 方面发挥作用。目前尚无充分证据确定 CRS 的疾病表型或患者种族是否会影响 CRS 后长期使用大环内酯类药物的疗效。
