New therapy for refractory chronic sinusitis in application with priming effect of macrolide on steroid therapy

点击翻译按钮获取中文摘要

In Japan long term low dose macrolide therapy is now a fundamental and standard pharmacotherapy for chronic rhiosinusitis (CRS), especially in neutrophil rather than eosinophil dominant type. Erythromycin, 14-memmbered macrolide, was originally and prevalently used as an appropriate macrolide therapy for CRS. Later, clarithromycin (CAM) and roxithromycin (RXM), new 14-membered macrolide, became practically in use in1990s. As to the mechanism of macrolide effects on CRS, anti-inflammation is regarded to be much more important than antibiotic effects; macrolide suppresses IL-8 production at the site of inflammatory mucosa and inhibits recruit and activation of neutrophils. Recently, quite refractory cases with pronounced eosinophil infiltration in nasal polyps or sinus mucosa are seen in 30~40% among CRS with nasal polyps (CRSwNP). Postoperative oral steroid is now only effective and practical therapy for “remission induction” of this type of CRS. However, long term or high dose oral steroids induce harmful side effects such as stomach ulcer, moon face, osteoporosis and susceptibility to infection. This study was designed in order to elucidate the priming effect of macrolide on steroids experimentally and clinically. In this experimental and clinical trials, CAM was chosen as a representative 14-membered macrolides. For steroids in the trials, Dexamethasone (DEX) was used in experiments and steroid nasal spray, Mometasone or Betamethasone, was prescribed clinically. Experimentally and clinically, priming effect of CAM was depending on the case. Further study is necessary to delineate in details what kind ofcases among refractory CRS cases are eligible for priming effect of macrolide on steroidtherapy.