Macrolide Therapy in Chronic Rhinosinusitis Management
Summary
Macrolide antibiotics, notably erythromycin, clarithromycin and azithromycin, have emerged as a valuable adjunct in the management of chronic rhinosinusitis through mechanisms that extend beyond direct antimicrobial activity. At low dose and over prolonged courses, these agents modulate mucosal immunity by down-regulating pro-inflammatory cytokines, inhibiting neutrophil recruitment, reducing mucus hypersecretion and enhancing mucociliary clearance. They appear most effective in non-type 2 inflammatory endotypes of rhinosinusitis, where neutrophil-driven inflammation predominates. Clinical benefits include symptom relief, polyp size reduction and quality-of-life improvement, particularly in patients refractory to corticosteroids or surgery. Nevertheless, responses are heterogeneous and may depend on endotype, dosage regimen and treatment duration. Ongoing research seeks to refine patient selection, optimise dosing schedules and define long-term safety, while balancing the risk of antibiotic resistance against sustained immunomodulatory advantages.
Research from Nature Portfolio
Experimental work in murine models of chronic rhinosinusitis has demonstrated that erythromycin attenuates nasal mucosal inflammation even in the presence of comorbid allergic rhinitis. Treatment reversed skewed Th1/Th2 cytokine profiles, markedly increased interleukin-10 expression and suppressed mucin gene MUC5AC, yielding effects comparable to, yet mechanistically distinct from, systemic corticosteroids. These findings underscore erythromycin’s capacity to inhibit immunoglobulin overproduction and mucus secretion in vivo, thereby supporting its role as an anti-inflammatory agent in chronic sinonasal disease.
Macrolide Therapy in Chronic Rhinosinusitis Management publication trend
The graph below shows the total number of articles in macrolide therapy in chronic rhinosinusitis management across all publications each year (not limited to Nature Index journals).
Technical terms
Macrolide: A class of antibiotics with both antimicrobial and immunomodulatory effects.
Cytokine: Small signalling proteins (e.g. interleukins, tumour necrosis factor) that regulate inflammation and immune cell activity.
Th1/Th2 cells: Subsets of T helper lymphocytes that drive cellular (Th1) or humoral (Th2) immune responses.
Mucociliary clearance: The coordinated removal of mucus and trapped particles from the sinonasal tract via ciliary motion.
Endotype: A disease subtype defined by distinct underlying biological mechanisms rather than clinical presentation alone.
MUC5AC: A major mucin gene whose product contributes to mucus viscosity and volume in airway epithelia.
References
- The Mechanism of Action and Clinical Efficacy of Low-Dose Long-Term Macrolide Therapy in Chronic Rhinosinusitis. International Journal of Molecular Sciences (2023).
- Erythromycin reduces nasal inflammation by inhibiting immunoglobulin production, attenuating mucus secretion, and modulating cytokine expression. Scientific Reports (2021).
- Time-dependent effect of clarithromycin on pro-inflammatory cytokines in CRS. Rhinology online (2022).
- Prospective evaluation of clarithromycin in recurrent chronic rhinosinusitis with nasal polyps. Brazilian Journal of Otorhinolaryngology (2019).
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