171 / 236
Post-FESS long-term macrolide therapy for NP
TABLE 9.
EAS (points)
Visits
Group 1
(antibiotics
24 weeks)
Group 2
(antibiotics
12 weeks)
Group 3
(control no
antibiotic)
Baseline
12.09
±
0.96
12.78
±
0.92
11.42
±
1.09
6 weeks
2.05
±
0.73
*
2.00
±
1.06
*
5.00
±
1.27
12 weeks
1.61
±
0.62
*
2.00
±
1.34
4.92
±
1.66
24 weeks
1.52
±
0.87
*
2.42
±
1.61
*
6.35
±
1.58
*Significant differences between study and control groups (
p
<
0.05).
EAS
=
endoscopic appearances score.
The most remarkable results occurred in the evaluation of
ECP concentration postoperatively. Before the surgery, me-
dian values of ECP concentrations in all 3 patients groups
did not differ significantly, being 412.2
±
123.1, 279.4
±
85.9, and 330.8
±
104.5, respectively. Six weeks after
surgery, the ECP level in the nasal discharge increased in
all study patients, being 553.2
±
115.5, 604.0
±
173.2,
and 660.0
±
171.6 ng/mL in groups 1, 2, and 3, respec-
tively. Twelve weeks after FESS, a significant decrease of
the ECP level in the nasal discharge was clearly observed
in group 1 (antibiotics for 24 weeks): 153.6
±
98.8 ng/mL
(
p
=
0.028), and in group 2 (antibiotics for 12 weeks):
290.4
±
77.2 ng/mL (
p
=
0.036). ECP level in the nasal
discharge in group 3 (control no antibiotics) patients did
not change significantly and was recorded as 654.0
±
184.9 ng/mL (
p
=
0.25). Only in group 1 (antibiotics
for 24 weeks) did the ECP concentration remain at the
same low level (154.8
±
89.8 ng/mL) at 24 weeks. In
group 2 (antibiotics for 12 weeks) there was a slight in-
crease of the ECP levels up to 338.1
±
83.1 ng/mL (
p
=
0.084) when these patients were studied at 24 weeks
(3 months after stopping the antibiotics); however, with
a
p
value of 0.084, the difference was not statistically
significant. The mean ECP level in the nasal discharge
in group 3 (control no antibiotics) rose significantly to
1000.0
±
222.7 ng/mL (
p
=
0.041) (Fig. 6, Table 10).
It is important to note that the ECP level in patients
treated with the macrolides over a full 6 months (group
1) was significantly lower than in those patients in group
2, who stopped the antibiotic therapy after 3 months of
treatment.
Side effects were uncommon with discontinuation of
antibiotic therapy required in only 3 patients. Liver
enzymes levels (alanine transaminase [ALT], aspartate
FIGURE 5.
Endoscopic appearance and CT scans of 26-year-old male patient (CRSwNP, bronchial asthma, 5 previous sinus surgeries) before and after FESS
followed by 6-month course of low-dose clarithromycin therapy. Before FESS: (A) large polyps completely block left nasal cavity; (B, C) total opacification of
paranasal sinuses and signs of osteitis on axial and coronal CT scans. Six months after FESS: (D) no visible polyps, multiple synechiae in the left ethmoid cavity;
(E, F) sinuses are pneumatized, slight thickening of the ethmoid mucosa. CRSwNP
=
chronic rhinosinusitis with nasal polyposis; CT
=
computed tomography;
FESS
=
functional endoscopic sinus surgery.
International Forum of Allergy & Rhinology, Vol. 4, No. 7, July 2014
149