Chronic rhinosinusitis and eosinophils: do macrolides have an effect?
OBJECTIVE
Long-term, low-dose macrolide therapy is effective in the treatment of chronic airway inflammation. It is believed that macrolide antibiotics produce this benefit through an antiinflammatory effect that is separate from their antibiotic effect. Eosinophils are key mediators in the inflammation seen in chronic rhinosinusitis. This review discusses the effect of macrolides on eosinophilic inflammation.


RESULTS
In vitro studies recently have suggested that macrolides increase eosinophil apoptosis and reduce production of eosinophil chemotactic cytokines and adhesion molecules. In vivo studies have shown a reduction in eosinophil count and activity in asthma and chronic rhinosinusitis. Clinical response to macrolide treatment is thought to be less likely in patients with atopy.


CONCLUSIONS
In contrast to the evidence supporting the effect of macrolides on neutrophilic inflammation, there are limited data to suggest an influence on eosinophilic inflammation. For this reason, patients with prominent eosinophilic inflammation may in the future be identified as being less likely to respond to treatment. Further in vitro and clinical studies are required to investigate this subject.
Wallwork
Ben
B
School of Biomolecular and Biomedical Science, Griffith University, Brisbane, Australia. benwallwork@hotmail.com
Coman
William
W
D000818:Animals; D002908:Chronic Disease; D004804:Eosinophils / Q000187:drug effects* / Q000502:physiology*; D006801:Humans; D018942:Macrolides / Q000494:pharmacology*; D012220:Rhinitis / Q000503:physiopathology*; D012852:Sinusitis / Q000503:physiopathology*
D018942:Macrolides