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The Role of Macrolides in Chronic Rhinosinusitis (CRSsNP and CRSwNP)

  • Rhinosinusitis (J Mullol, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We assess the literature on the pharmacokinetics, indications, important considerations, and effectiveness of long-term, low-dose macrolide antibiotics in chronic rhinosinusitis (CRS).

Recent Findings

The key to effective implementation of macrolide therapy in CRS is appropriate patient selection. Macrolides have demonstrated the most benefit in Th1-mediated non-eosinophilic CRS when used for durations of at least 3 months.

Summary

Macrolide antibiotics have demonstrated great benefit when used for their anti-inflammatory or immunomodulatory properties, which include the blockage of pro-inflammatory cytokines, such as interleukin (IL)-8 and tumor necrosis factor-α (TNF-α). They have been used in CRS patients not responding to traditional corticosteroid-based treatment regimens, but appear to be most effective specifically in Th1-mediated non-eosinophilic CRS in long durations and low doses. Further research is needed to better identify characteristics known to correlate with macrolide response so early directed therapy can be implemented.

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Authors and Affiliations

  1. Division of Otolaryngology–Head and Neck Surgery, University of Utah, 50 N. Medical Dr., 3C120, Salt Lake City, UT, 84132, USA

    Gretchen M. Oakley

  2. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia

    Richard J. Harvey

  3. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia

    Richard J. Harvey

  4. Royal National Throat, Nose and Ear Hospital, London, UK

    Valerie J. Lund

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  1. Gretchen M. Oakley
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  2. Richard J. Harvey
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Correspondence to Gretchen M. Oakley.

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Dr. Oakley declares no conflicts of interest relevant to this manuscript. Dr. Lund reports personal fees from MSD, Crucell (Johnson and Johnson), NeilMed, Vitaccess, Vifor, GSK, and Abbott. Dr. Harvey reports grants and personal fees from Olympus, Medtronic, Neilmed, and Seqiris.

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Oakley, G.M., Harvey, R.J. & Lund, V.J. The Role of Macrolides in Chronic Rhinosinusitis (CRSsNP and CRSwNP). Curr Allergy Asthma Rep 17, 30 (2017). https://doi.org/10.1007/s11882-017-0696-z

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