Clinical and Microbiological Evaluation of Long Term Clarithromycin in the Treatment of Chronic Rhinosinusitis
Abstract: The overall aim of the present study was to examine the effect of long-term, low-dose clarithromycin treatment of a population with chronic sinusitis who did not respond to sinus surgery and traditional conservative therapy. Thirty nine patients with persistent symptoms of chronic sinusitis were studied. They had all been treated with systemic steroids and long-term antibiotics other than macrolides. A nasal swab was performed at each visit for microbiological evaluation and the microorganisms were identified by using standard bacteriological identification procedures. All patients were treated with Clarithromycin 500 mg 2x daily with other routine medication of chronic rhinosinusitis. Twenty six patients responded to the treatment (66.6%). There were no significant statistical differences between non-responders and responders in defined parameters at study commencement. After 3 months of treatment, endoscopes nasal examination scoring improved (p<0.05). In the Visual Analog Scale (VAS) scoring, the most significant change was in nasal obstruction (p<0.05). According to the results of microbiological investigation, Staphylococcus aureus was the most prevalent organism isolated from patients followed by Pseudomonas aureginosa and coagulase negative staphylococcus. At 3 months, the number of positive cultures were reduced with no S. aureus isolated. The results of present study suggest that long-term, macrolide antibiotic therapy is effective in the majority of surgical failures of chronic sinusitis. We recommend a minimum treatment period of 3 months to evaluate the efficacy of the treatment.