One-year low-dose erythromycin treatment of persistent chronic sinusitis after sinus surgery: clinical outcome and effects on mucociliary parameters and nasal nitric oxide.
OBJECTIVE
In 17 patients with chronic sinusitis persistent after sinus surgery, long-term, low-dose erythromycin therapy was tested. The aim of the investigation was to study the clinical outcome and effects on nasal nitric oxide (NO), ciliary beat frequency (CBF), and mucociliary transport (saccharine transit time).


METHODS
We conducted a prospective open study at a tertiary teaching hospital. Symptoms were assessed using visual analog scales. NO was measured using a chemiluminescence analyzer, and mucociliary transport was measured with the saccharine crystal technique. CBF was measured in nasal brush samples using a phase contrast microscope. All patients were treated with erythromycin succinate 250 mg 2x daily or clarithromycin 250 mg 1x daily and were assessed after 3 months. In cases where there was no response, treatment was abandoned. The remaining patients (responders) were reassessed after 12 months of treatment.


RESULTS
Of 17 patients, 12 responded to treatment. The 12-month follow-up showed an improvement in saccharine transit time (P < 0.05) but no significant change in CBF. There was a trend toward an increase in NO (P = 0.12). Endoscopic nasal examination scoring improved significantly (P < 0.01). In the visual analog scale scoring, the most pronounced improvements were seen in nasal congestion, sticky secretion, and runny nose at 3 and 12 months (P < 0.01). Improvements were also seen in headache (P < 0.05).


CONCLUSIONS
The present study suggests that long-term, low-dose treatment with erythromycin is effective in persistent chronic sinusitis that does not respond to sinus surgery or systemic steroid/antibiotic treatment.


CONCLUSIONS
Long-term, low-dose erythromycin therapy seems to be a promising alternative when more conventional therapy fails. However, placebo-controlled studies are needed to validate the potential of this treatment.
Cervin
Anders
A
Department of Otorhinolaryngology-Head and Neck Surgery, Lund University, Sweden. anders.cervin@onh.lu.se
Kalm
Olof
O
Sandkull
Per
P
Lindberg
Sven
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D002908:Chronic Disease; D002923:Cilia / Q000187:drug effects / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D004917:Erythromycin / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009079:Mucociliary Clearance / Q000187:drug effects* / Q000502:physiology; D009569:Nitric Oxide / Q000032:analysis*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012008:Recurrence; D012852:Sinusitis / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D017211:Treatment Failure
D000900:Anti-Bacterial Agents; D009569:Nitric Oxide; D004917:Erythromycin