173 / 236
Post-FESS long-term macrolide therapy for NP
the standard of care in the United Sates and some other
Western countries, especially in the setting of postoperative
eosinophilic inflammation flare-up. However, in countries
such as Russia where systemic corticosteroid therapy in
CRSwNP is extremely uncommon, long-term macrolides
therapy might be an alternative option because it carries
less risk of systemic side effects.
We did not find an increase in macrolide resistant bacte-
rial cultures from the middle meatus after a long-term, low-
dose course 250 mg/day of clarithromycin therapy, agreeing
with previous studies that also failed to find resistant mi-
croorganisms after long-term treatment with azithromycin
and erythromycin.
17,20
Of course, the risk of developing
antibiotic-resistant strains of bacteria induced by the long-
term macrolide therapy is always possible.
Although a placebo arm was not designed into our pro-
tocol and patients were not blinded when receiving addi-
tional therapy, we evaluated 6 different objective methods
in all 3 study groups. All investigators were blinded when
evaluating and grading the results of nasal endoscopy, CT
scans, and all other tests. A future randomized double-blind
placebo-controlled study, with a large sample size, would
be required to determine the efficacy of long-termmacrolide
therapy, particularly in preventing the recurrence of nasal
polyps after FESS. In addition, such a study could hopefully
predict which CRSwNP patients would benefit from long-
term antibiotic treatment and if this treatment increases the
risk of inducing significant bacterial resistance.
Conclusion
Results of this study demonstrated the efficacy and rela-
tive safety of long-term (6 months) low-dose (250 mg/day)
macrolide (clarithromycin) therapy for preventing early re-
currence of nasal polyps in patients with CRSwNP after
FESS. Despite limited clinical data, our evidence suggests
that patients with recurrent CRSwNP (surgical failures) de-
serve a trial of low-dose clarithromycin treatment (250 mg
daily for 3-6 months), which may be initiated immediately
after FESS along with maintenance therapy using topical
nasal steroids.
Acknowledgments
We thank Prof. Kirill Zykov and his team (Laboratory for
Immunopathology of Cardiovascular Diseases, Cardiology
Research Center) for invaluable help with ECP measuring
and competent scientific interpretation of the study results.
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