A study of poor responders for long-term, low-dose macrolide administration for chronic sinusitis.
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.
Haruna
Shinichi
S
Department of Otolaryngology, The Dokkyo Medical University School of Medicine, Tochigi, Japan. haruna@dokkyomed.ac.jp
Shimada
Chieko
C
Ozawa
Masashi
M
Fukami
Satoru
S
Moriyama
Hiroshi
H
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
D000900:Anti-Bacterial Agents; D015575:Roxithromycin; D017291:Clarithromycin