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Oral Antibiotics as Anti-inflammatories

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Practical Medical and Surgical Management of Chronic Rhinosinusitis

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Abstract

Chronic rhinosinusitis is an inflammatory disease of the nasal and sinus mucosa. While there are multiple mechanisms by which inflammation takes place, the processes can be classified as eosinophil dominant or neutrophil dominant. Eosinophil dominant inflammation can be associated with allergen exposure and local or systemic IgE production. It is characterized by Th2 cells and IL-5. Neutrophil-dominant inflammation is triggered by mucosal exposure to microorganisms. It is characterized by Th1 and IL-8. Both eosinophils and neutrophils release cellular contents that contribute to tissue damage and inflammation.

Antibiotics have been increasingly investigated for their anti-inflammatory effects. In the setting of chronic rhinosinusitis, macrolide and tetracycline antibiotics have been trialed for their anti-inflammatory properties. The anti-inflammatory mechanisms of macrolides include the downregulation of proinflammatory genes, improvement of mucociliary function, and decreased neutrophil accumulation. Observational studies provide support for a prolonged trial of macrolide therapy when conventional therapies fail, especially in patients with low serum IgE levels. Tetracyclines exert anti-inflammatory effects by decreasing inflammatory factors, decreasing neutrophil chemotaxis, and decreasing IgE production. Tetracyclines were shown in one study to decrease nasal polyp size but without any lasting symptom improvement. More research is required to establish the utility of tetracyclines in chronic rhinosinusitis. Other antibiotics with anti-inflammatory effects are trimethoprim-sulfamethoxazole and dapsone, but neither has been applied to the rhinologic setting at present.

Antibiotics have a promising role in becoming effective adjunct therapy in patients who have refractory chronic rhinosinusitis. With the evidence currently available, macrolides are a reasonable option in patients with challenging disease. More evidence is needed, however, before tetracyclines can be routinely recommended.

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Authors and Affiliations

  1. Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, Foothills Medical Centre, University of Calgary, South Tower Room 602, 1403 29th Street NW, Calgary, AB, T2N 2T9, Canada

    C. Carrie Liu MD & Luke Rudmik MD, MSc

  2. Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Oregon Sinus Center, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, PV01, Portland, OR, 97239, USA

    Timothy L. Smith MD, MPH

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  1. C. Carrie Liu MD
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  2. Timothy L. Smith MD, MPH
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Correspondence to Luke Rudmik MD, MSc .

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  1. Department of Otorhinolaryngology Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Pete S. Batra

  2. Department of Otolaryngology and Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA

    Joseph K. Han

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Liu, C.C., Smith, T.L., Rudmik, L. (2015). Oral Antibiotics as Anti-inflammatories. In: Batra, P., Han, J. (eds) Practical Medical and Surgical Management of Chronic Rhinosinusitis. Springer, Cham. https://doi.org/10.1007/978-3-319-16724-4_13

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  • DOI: https://doi.org/10.1007/978-3-319-16724-4_13

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