Macrolide antibiotics in the treatment of chronic rhinosinusitis: evidence from a meta-analysis.

BACKGROUND

The purpose of this study was to systematically assess the subjective and objective outcomes of macrolide therapy for chronic rhinosinusitis (CRS).

METHODS

PubMed, Embase and Cochrane databases were searched for clinical trials detailing the effects of macrolide therapy in patients with CRS and published up to December 2017. Sino-Nasal Outcome Test (SNOT), endoscopic scores and computed tomography scans (CT) scores were assessed by mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval. Subgroup analyses were performed to evaluate the source of heterogeneity according to study design and geographic locations. I2 metric was used to assess the heterogeneity.

RESULTS

Seven randomised clinical trials (RCTs) and four cohort trials meeting pre-determined selection criteria were enrolled in this meta-analysis. Assessment of the findings for SNOT after 12 weeks' macrolide treatment demonstrated a significant improvement in subgroup of trials in Asian patients (SMD =-0.51; 95% CI: -0.96, -0.02; P=0.04), but not in non-Asians (SMD =-0.01; 95% CI: -0.65, 0.63; P=0.98). At 12 or 24 weeks' visit no significant difference in SNOT was noted compared with control group, either in RCTs or cohort trials subgroups. However, findings for endoscopic scores were found to be significantly improved compared to placebo in the subgroup of non-RCT studies after 8 weeks (SMD =-0.77; 95% CI: -1.07, -0.46; P<0.00001) and 12 weeks (SMD=-1.40; 95% CI: -1.97, -0.82; P<0.00001) of macrolide therapy. Similarly, findings for CT scores showed significant improvements in CT scores compared to baseline after 12 weeks' treatment (MD=-5.81; 95% CI: -8.10, -3.52; P<0.00001) in cohort trials.

CONCLUSIONS

Macrolide therapy can significantly improve endoscopic and CT scores in CRS patients, compared to baseline. Further well-designed studies are needed to confirm the efficacy and safety of macrolides in CRS treatment.