副鼻腔炎に対するマクロライド療法の現状

Abstract

The clinical efficacy of low-dose and long-term Macrolide therapy such as Erythromycin (EM), Roxithromycin (RXM), and Clarithromycin (CAM) in the treatment of chronic sinusitis was analysed retrospectively over the past 8 year period as represented in the Japanese literature.Patients treated with these macrolides demonstrated an improvement in both quality and quantity of nasal discharge. Notably, patients who received RXM demonstrated better improvement of rhinorrhea than patients treated with EM or CAM. CAM was judged to be useful in the treatment of sinusitis in children, showing greater improvement and a faster recovery period as compared to improvements in adults.The Excellent synergism of both Ciprofloxacin and RXM or CAM on P. aeruginosa in biofilms was discussed from the standpoint of their pharomacological action in biofilms. Combined therapy using sinus irrigation or a YAMIK catheter for treatment of sinus secretion and macrolide administration was presented as a new therapeutic modality for treatment of chronic sinusitis.Drug interactions with EM, CAM, but not with RXM, and antiallergic agents such as Terfenadine and Astemisole were demonstrated as one of the adverse effects occurring in clinical practice.