Immunomodulatory treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP) by macrolide antibiotics represents a challenging alternative to conventional therapy and surgery, still being at ...the very beginning. Immune and inflammatory processes in nasal and paranasal sinus mucosa, crucial in the etiopathogenesis of nasal polyps (NPs) are reflected in levels of various local mediators, found both in mucosa and nasal fluid. In this prospective study, we assessed the immunomodulatory and clinical effects of longterm low-dose oral macrolide treatment in the management of CRSwNP. Twenty-two (n = 22) nonasthmatic, nonallergic patients with CRSwNP were administered clarithromycin (CAM) 500 mg/day single oral dose for eight weeks. We measured the levels of proinflammatory cytokines TNF-α, TNF-β, and IL-1β, Th1 cytokines IL-2, IL-12, and IFN-γ, Th2 cytokines IL-4, IL-5, IL-6, and IL-10, and chemokine IL-8 in the nasal fluid samples, before and after treatment, using a flow cytometric method. We also scored each of the 22 patients before and after therapy according to Tsicopoulos' global nasal symptom score and Malm's endoscopic score. Following treatment, we found significantly reduced levels of IL-8 (p<0.01) and TNF-α (p<0.01) in nasal secretions. Macrolide therapy decreased the size of polyps in 45.45% of the patients. We concluded that long-term low-dose treatment with CAM was effective in the management of CRSwNP. We suggest that macrolides can be an alternative to topical and systemic corticosteroids in the management of CRSwNP.
Mada je u samim začecima, imunomodulacijska terapija hroničnog rinosinuzitisa sa nosnom polipozom (HRSsNP) primenom makrolidnih antibiotika bi mogla predstavljati alternativu uobičajenoj konzervativnoj terapiji, kao i hirurškom lečenju. Imunski i zapaljenski procesi u sluzokoži nosa i paranazalnih sinusa, najznačajniji u etiopatogenezi nosnih polipa, reflektuju se na različite lokalne medijatore, detektovane u sluzokoži kao i u nosnom sekretu. U ovoj prospektivnoj studiji procenili smo imunomodulacijske i kliničke efekte dugotrajne niskodozirane oralne primene makrolidnog antibiotika u lečenju HRSsNP. Dvadeset dvoje (n = 22) neastmatičnih, nealergičnih pacijenata sa HRSsNP dobijalo je klaritromicin (CAM) u pojedinačnoj dnevnoj dozi od 500 mg tokom osam nedelja. Merene su koncentracije proinflamatornih citokina TNF-α, TNF-β i IL-1β, Th1-citokina IL-2, IL-12 i IFN-γ, Th-2-citokina IL-4, IL-5, IL-6 i IL-10, kao i hemokina IL-8 u uzorcima nosnog sekreta, pre i nakon terapije, primenom protočne citometrije. Svaki od pacijenata klinički je klasifikovan pre i posle lečenja prema Tsicopoulosovom ukupnom nosnom simptom skoru i Malm-ovom endoskopskom skoru. Nakon lečenja, detektovane su značajno niže koncentracije IL-8 (p<0,01) i TNF-α (p<0,01) u nosnom sekretu. Terapija makrolidnim antibiotikom je smanjila veličinu polipa kod 45,45% od ukupnog broja pacijenata. Zaključeno je da je dugotrajna niskodozirana primena CAM korisna u lečenju HRSsNP. Makrolidi mogu biti prihvaćeni kao alternativa topikalnim i sistemskim kortikosteroidima u terapiji HRSsNP.
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