title: A study of poor responders for long-term, low-dose macrolide administration for chronic sinusitis.
abstract: OBJECTIVE
  We investigated the clinical factors (CT images, endoscopic nasal findings and allergic factors) involved in resistance of chronic sinusitis to macrolide therapy (ME) retrospectively.
  
  
  METHODS
  ME was administered for 8-20 weeks in 68 adults with chronic sinusitis cases. The effect was evaluated in each factor from radiographic findings (R0-R3 according to the severity of the images), nasal findings (N0: no polyp, N1: a single polyp and N2: multiple polyps), allergic factors (A0: no allergy, A1: nasal allergy, A2: bronchial asthma) and objective nasal symptoms. In addition, an effect after polypectomy and histological examination were assessed for N1 and N2 groups.
  
  
  RESULTS
  ME was effective in 70.6% (48/68 patients). The efficacy of ME was significantly less in the polyp group compared with the polyp-free group (p < 0.05). Therapeutic efficacy was significantly different between R1 and R3 groups (p < 0.05) with a tendency for worse outcome from R1 to R3. The efficacy in asthma patients was significantly less compared with patients with allergic rhinitis or no allergy (p < 0.05). The efficacy after polypectomy was significantly improved in N2 group but not in N1 group. The number of eosinophil/total inflammatory cells (%) in nasal polyps of resistant cases was significantly higher than in marked improved cases.
  
  
  CONCLUSIONS
  The efficacy of ME was less in patients with polyposis; CT scans indicating severe findings, bronchial asthma and polyps with increased eosinophil infiltrations. Polypectomy resulted in significant improvement in the efficacy of ME.
authors.affiliation: Department of Otolaryngology, The Dokkyo Medical University School of Medicine, Tochigi, Japan. haruna@dokkyomed.ac.jp
authors.forename: Shinichi
authors.initials: S
authors.lastname: Haruna
authors.forename: Chieko
authors.initials: C
authors.lastname: Shimada
authors.forename: Masashi
authors.initials: M
authors.lastname: Ozawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Fukami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Moriyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D017291:Clarithromycin / Q000627:therapeutic use*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015575:Roxithromycin / Q000627:therapeutic use*; D012852:Sinusitis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015575:Roxithromycin; D017291:Clarithromycin