Macrolides and upper airway/sinus disease

Abstract

Historically, macrolides were first used for chronic sinusitis as immunomodulatory mediators in Japan. In Japan, 14-membered-ring macrolide antibiotics had been routinely used for the treatment of diffuse panbronchiolitis (DPB) since Kudoh reported that long-term, low-dose oral administration of erythromycin (EM) was effective for the disease in 1987 [1]. DPB is a disease of unclear etiology, characterized by chronic inflammation in the respiratory bronchioles. DBP is not uncommon in Japan, but is rare elsewhere. More than 75% of diffuse panbronchiolitis patients have chronic sinusitis, and chronic sinusitis associated with diffuse panbronchiolitis improves during macrolide treatment. EM was originally recovered from a soil sample from the Philippine archipelago. It is the metabolic product of a strain of Streptomyces erythreus, discovered by McGuire and co-worker in 1952. Clarithromycin (CAM), roxithromycin (RXM) and azithromycin (AZM) are new semi-synthetic derivatives of EM. Not only EM but also other 14and 15membered-ring macrolides have been proven to be effective for diffuse panbronchiolitis. Macrolide is now widely used for chronic sinusitis and otitis media in Japan. In this chapter, we will discuss clinical results of macrolide for chronic sinusitis, nasal polyps, and otitis media with effusion.