Long term oral azithromycin versus functional endoscopic sinus surgery in patients suffering from chronic rhinosinusitis: a comparative study

Authors

  • Garima Yadav Department of ENT, SHKM GMC, NUH, Haryana, India
  • Mayank Yadav Department of ENT, SHKM GMC, NUH, Haryana, India
  • Deeksha Nautiyal Department of ENT, MAMC, New Delhi, India
  • T. S. Anand Delhi Heart Institute, New Delhi, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20212125

Keywords:

Chronic rhinosinusitis, Macrolide, Azithromycin, FESS

Abstract

Background: Chronic rhinosinusitis (CRS) is defined as inflammation of the nasal cavity and paranasal sinuses. Azithromycin, a macrolide antibiotic, a well-established class of anti-bacterial agents, which also have anti-inflammatory properties. The present study was designed to compare the role of azithromycin with surgical management in patients with chronic-rhinosinusitis.

Methods: The study population included 60 adult patients with symptomatic CRS refractory to 3 weeks of medical therapy. The patients were divided in two groups with 30 patients in each group. One group of patients received oral Azithromycin as main treatment for 12 weeks while the other group of patients underwent sinonasal surgery. Symptom scoring and endoscopic scoring were done previous to the treatment and at 1 month and 3-month follow-ups.

Results: A good subjective as well as objective outcome in terms of symptom improvement was obtained with in patients with chronic rhinosinusitis with Surgical intervention as compared to those patients who received long term oral Azithromycin.

Conclusions: We advocate that patients suffering from chronic sinonasal disease should be initially targeted with maximal medical therapy using an oral macrolide for at least 3 months. After this patient should be assessed and surgery considered in those cases refractory to medical therapy.

Author Biographies

Garima Yadav, Department of ENT, SHKM GMC, NUH, Haryana, India

Assistant Professor

Department of ENT

SHKM GMC 

NUH

Mayank Yadav, Department of ENT, SHKM GMC, NUH, Haryana, India

Assistant Professor
Department of ENT
SHKM GMC
NUH

Deeksha Nautiyal, Department of ENT, MAMC, New Delhi, India

Senior Resident 

Department of ENT

T. S. Anand, Delhi Heart Institute, New Delhi, India

Senior Consultant 

Department Of ENT

References

Lanza DC. Diagnosis of Chronic Rhinosinusitis. Annal Otol Rhinol Laryngol. 2004;113:10-4.

Benninger MS. The medical management of rhinosinusitis. Otolaryngol Head Neck Surg. 1997;117(3 Pt 2):S41-9.

Proctor DF. The nose, paranasal sinuses and pharynx. Inwaters Wed lewi’s Walters practice of surgery.Hagerstown.Md.WF prior. 1966;1-37.

Kennedy DW, Zienreich SJ, Rosenbaum AE, Johns ME. Functional endoscopic sinus surgery. Theory and diagnostic evaluation. Arch Otolaryngol. 1985;111(9):576-82.

Chow JM, Stankiewicz JA. A diagnostic dilemma for chronic rhinosinusitis; definition, accuracy and validity. Am J Rhinol. 2002;16(4):199-202.

Georgitis IW, Matthews RI, Stone R. Chronic sinusitis: characterization of cellular influx and inflammatory mediators in sinus lavage fluid. Int Arch Allergy Immunol. 1995;106(4):416-21.

Gwaltney JM Jr: Acute community-aquired sinusitis. Clin infect Dis. 1996;23(6),1209-23.

Reilly JS. The sinusitis cycle. Otolaryngol Head Neck Surg. 1990;103:856.

Asano K, Suzuki M, Shimane T, Suzaki H. Suppression of co-stimulatory molecule expressions on splenic B lymphocytes by a macrolide antibiotic, roxithromycin in vitro. Int Immunopharmac. 2001;1:1385-92.

Keichou N, Kudoh S: Diffuse panbronchiolitis: role of macrolides in therapy. Am J Respir Med. 2002;1(2):119-31.

Kanai K, Asano K, Hisamitsu T, Suzaki H: Suppression of matrix metalloproteinase production from asal fibroblast production by macrolide antibiotics in vitro. Eur Respir J. 2004;23(5):671-8.

Nadel JA: Inflammation and asthma. J Allergy Clin Immunol. 1984;73:651-3.

Muranaka H, Suga M, Sato K, Nakagawa K, Akaike T, Okamoto T, et al. Superoxide scavenging activity of erythromycin-iron complex. Biochem Biophys Res Commun. 1997;232(1):183-7.

Culic O, Erakovic V, Parnham MJ. Anti-inflammatory effects of antibiotics. Eur J Pharmacol. 2001;429(1-3):209-29.

Bachert C, Wagenmann M, Rudack C, Höpken K, Hillebrandt M, Wang D, et al. The role of cytokines in infectious sinusitis and nasal polyposis. Allergy. 1998;53(1):2-13.

Demoly P, Crampette L, Mondain M, Enander I, Jones I, Bousquet J. Myeloperoxidase and interleukin-8 levels in chronic sinusitis. Clin Exp Allergy. 1997;27:672-5.

Rudack C, Stoll W, Bachert C. Cytokines in nasal polyposis, acute and chronic sinusitis. Am J Rhinol. 1998;12(6):383-8.

Raghab SM, Lund VJ, Scadding G. Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial. Laryngoscope. 2004;114(5):923-30.

Alexander G, Chiu and David W, Kennedy. Disadvantages of minimal techniques for surgical management of chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2004,12:38-42.

Omura S. Macrolide antibiotics; chemistry, biology and practice, 2nd edn. Amsterdam; Boston: Academic Press, 2002.

Tamaoki J. The effects of macrolides on inflammatory cells. Chest 2004;125(2Suppl.):41S-50S.

Videler WJ, Badia L, Harvey RJ, Gane S, Georgalas C, Van der Meulen FW, et al. Lack of efficacy of long term, low dose azithromycin in chronic rhinosinusitis: a randomized controlled trial. Allergy. 2011;66:1457-68.

Smith TL, Kern R, Palmer JN, Schlosser R, Chandra RK, Chiu AG, et al. Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study with 1-year follow-up. Int Forum Allergy Rhinol. 2013;3:4-9.

Maniakas A, Desrosiers M. Azithromycin add-on therapy in high-risk post endoscopic sinus surgery patients failing corticosteroids irrigations; A clinical practice audit. Am J Rhinol Allergy. 2014;28(2):151-5.

Amali A, Saedi B, Ezabadi SR. Long term post-operative azithromycin in patients with chronic rhinosinusitis: A randomised clinical trial. Am J Rhinol Allergy. 2015;29(6);421-4.

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Published

2021-05-26

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Original Research Articles