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[Macrolide therapy on nasal mucosal persistent refractory inflammation after endoscopic sinus surgery].

OBJECTIVE
To examine the clinical effect of low-dose (250 mg/d), long-term (12 - 28 weeks) macrolide Klacid on the persistent refractory inflammation of paranasal sinus mucosa following endoscopic sinus surgery (ESS).


METHODS
Thirteen patients from a consecutive series of 141 patients undergoing ESS for chronic rhinosinusitis (CRS) during 2004 - 2006 for the first time were recruited for persistent refractory inflammation over 2 years postoperatively. All patients were given Klacid 250 mg/d orally for 12 - 28 weeks and simultaneously maintained the usual treatment including intranasal corticosteroid, mucolytics, and nasal douche. At the end of treatment and the sequential 3 and 6 months, 13 patients were evaluated by symptoms of visual analogue scale and nasal endoscopy by Lund-Kennedy scoring system, respectively.


RESULTS
Among the 13 patients, 1 patient stopped therapy for no obvious benefit 5 months after treatment, 12 patients finished the planned treatment till achieving the stopping therapy standard. Ultimately both symptom (8.00 [7.50, 8.50] and 1.00 [0.25, 1.00], Z = -3.201, P < 0.01) and endoscopic evaluation (7.00 [6.50, 8.00] and 1.00 [0.00, 1.00], Z = -3.194, P < 0.01) showed total remarkable improvement after therapy in 13 patients. The comprehensive assessment showed very good outcomes in 6 cases, good in 6 cases, and no good outcomes in 1 case, respectively. During the sequential 3 months and 6 months, no recurrent sinusitis and side effect happened in any patients.


CONCLUSIONS
It is effective to treat chronic refractory sinusitis with a low-dose (250 mg/d), long-term (12 - 28 weeks) Klacid on nasal mucosal persistent refractory inflammation after ESS. Klacid is well tolerated and safe to CRS patients during the use of 12 - 28 weeks.