Macrolides for Rhinosinusitis and Nasal Polyps

Low-dose and long-term administration of a 14- or 15-membered ring macrolide (macrolide therapy) is well known to be effective in the treatment of chronic airway inflammatory diseases, including diffuse panbronchiolitis, chronic rhinosinusitis (CRS), and cystic fibrosis. The mechanism of action of macrolide therapy is probably immunomodulatory rather than antibacterial. In CRS, macrolide therapy appears to be particularly effective when there is neutrophil-dominant (T17) inflammation, and where there is mucus hypersecretion with nasal discharge and posterior rhinorrhea. However, macrolide therapy is not very effective for CRS with eosinophil-dominant (T2) inflammation, characterized by serum and tissue eosinophilia.