The efficacy of combined medical treatment antihistaminics, steroid s, and macrolide antibiotics in patients with nasal polyposis: preliminary results

Year 2002, Volume: 9 Issue: 5, 352 - 357, 10.10.2002

Sinan Kocatürk Gökhan Kuran Selma Kurukahvecioğlu Ünsal Erkam

Abstract

Objectives: We evaluated the efficacy of combined med­ ical treatment in cases with bilateral nasal polyposis vvithout a history of any surgical or medical treatment.Patients and Methods: Twenty-five patients 19 males, 6 females; mean age 45 years; range 30 to 60 years who had not received any treatment for bilateral nasal polyposis were included. Treatment was comprised of an oral anti-histaminic agent single dose daily for 3 weeks , and a topical steroid as a nasal spray, twice daily for 6 months and a single dose of intramuscular systemic steroid. Patients who did not respond to this therapy at the end of three weeks were administered a macrolide antibiotic clarithromycin . The results were evaluated before treatment, and three weeks and six months after treatment with the use of a patient questionnaire, com- puted tomography and endoscopic examination findings.Results: The patients’ complaints improved by 85.5% and 79% at the end of three weeks and six months, respectively p<0.005 . Radiologic improvement was found to be 64% at the end of six months p<0.005 .The overall decrease in the size of the polyps was significant p<0.005 . No treatment-associated complications were encountered.Conclusion: Significant improvement achieved favors the use of combined medical treatment before surgery in selected patients with nasal polyposis.

Keywords

Anti-inflammatory agents, steroidal/therapeutic use, antibiotics, macrolide/therapeutic use, clarithromycin/therapeutic use, drug therapy, combination, glucocorticoids/therapeutic use, histamine H1 antagonists, nasal polyps/drug therapy/ radiography, tomography, X-ray computed, treatment outcome

Nazal polipozisli hastalarda kombine antihistaminik, steroid ve makrolid tedavisinin etkinliği: On sonuçlar

Abstract

Amaç: Önceden medikal veya cerrahi tedavi görmemifliki taraflı nasal polipozisli olgularda kombine medikaltedavinin etkinliğini değerlendirdik. Hastalar ve Yöntemler: Çalıflmaya iki taraflı nasal polipozisli ve önceden ameliyat geçirmeyen 25 hasta alındı. Hastalaramedikal tedavi olarak oral antihistaminik günde tek doz,üç hafta , topikal nazal steroidli sprey günde iki kez, altıay ve tek doz intramusküler sistemik steroid uygulandı.Üç haftalık tedaviye yanıt vermeyen hastalara makrolidgrubu klaritromisin antibiyotik verildi. Hastaların tedaviye yanıtları subjektif olarak semptomlara yönelik anketformu ile, objektif sonuçlar ise bilgisayarlı tomografi bulguları ve endoskopik muayene skorlarına göre değerlendirildi. Tedaviden sonra üçüncü hafta ve altıncı aydaki son u ç l a r, tedavi öncesi bulgularla karflılafltırıldı.Bu l g u l a r : Üçüncü hafta ve altıncı ayın sonunda hastaların flikayetlerinde sırasıyla %85.5 ve %79 oranlarında iyileflme görüldü p

Keywords

Antienflamatuvar ajanlar, steroidal/terapötikkullanım, antibiyotik, makrolid/terapötik kullanım, klaritromisin/terapötik kullanım, ilaç tedavisi, kombine, glukokortikoid/ terapötik kullanım, histamin H1 antagonistleri, nazal polip/ilaçtedavisi/radyografi, bilgisayarlı tomografi, tedavi sonucu

References

• Drake-Lee AB. Nasal polyps. In: Kerr AG, editor. Scott-Brown’s otolaryngology. Vol. 4, 6th ed. London: Butterworth-Heinemann, Reed Educational and P rofessional Publishing; 1997. p. 1-10.
• Larsen PL, Tos M. Origin of nasal polyps. Laryngoscope 1 9 9 1 ; 1 0 1 : 3 0 5 - 1 2 .
• Settipane GA, Klein DE, Settipane RJ. Nasal polyps. State of the art. Rhinol Suppl 1991;11:33-6.
• Frenkiel S, Chagnon F, Small P, Rochon L, Cohen C, Black M. The immunological basis of nasal polyp for- mation. J Otolaryngol 1985;14:89-91.
• Holmberg K, Karlsson G. Nasal polyps: medical or s u rgical management? Clin Exp Allergy 1996;26 Suppl 3: 23-30.
• Radenne F, Lamblin C, Vandezande LM, Ti l l i e - L e b l o n d I, Darras J, Tonnel AB, et al. Quality of life in nasal poly- posis. J Allergy Clin Immunol 1999;104:79-84.
• Mosges R, Klimek L. Azelastine reduces mediators of inflammation in patients with nasal polyps. Allergy Asthma Proc 1998;19:379-83.
• Kutting B, Nieschalk M, Brehler R. A new concept for t reatment of sinonasal polyposis. Allergy 2000;55:1091-2.
• Mygind N. Effects of corticosteroid therapy in non-aller- gic rhinosinusitis. Acta Otolaryngol 1996;11 6 : 1 6 4 - 6 .
• Settipane GA. Nasal polyps: epidemiology, pathogen- esis and treatment. 5th ed. Rhode Island: Ocean Side Publications; 1997.
• Mygind N, Lildholdt T. Nasal polyps treatment: med- ical management. Allergy Asthma Proc 1996;17:275-82.
• Nonaka M, Pawankar R, Saji F, Yagi T. Effect of ro x- i t h romycin on IL-8 synthesis and proliferation of nasal polyp fibroblasts. Acta Otolaryngol Suppl 1998;539:71-5.
• Suzuki H, Shimomura A, Ikeda K, Furukawa M, Oshima T, Takasaka T. Inhibitory effect of macrolides on interleukin-8 secretion from cultured human nasal epithelial cells. Laryngoscope 1997;107:1661-6.
• Cervin A. The anti-inflammatory effect of erythro m y c i n and its derivatives, with special reference to nasal polyposis and chronic sinusitis. Acta Otolaryngol 2001; 12:83-92.
• Vendelo Johansen L, Illum P, Kristensen S, Winther L, Vang Petersen S, Synnerstad B. The effect of budesonide (Rhinocort) in the treatment of small and medium-sized nasal polyps. Clin Otolaryngol 1993;18:524-7.
• Lund VJ, Mackay IS. Staging in rh i n o s i n u s i t u s . Rhinology 1993;31:183-4.
• Kennedy DW. Prognostic factors, outcomes and stag- ing in ethmoid sinus surgery. Laryngoscope 1992;102 (12 Pt 2 Suppl 57):1-18.
• Rice DH. Endoscopic sinus surgery: results at 2-year fol- lowup. Otolaryngol Head Neck Surg 1989;101:476-9.
• Wigand ME, Hosemann WG. Results of endoscopic surgery of the paranasal sinuses and anterior skull base. J Otolaryngol 1991;20:385-90.
• Damm M, Jungehulsing M, Eckel HE, Schmidt M, Theissen P. Effects of systemic steroid treatment in chronic polypoid rhinosinusitis evaluated with mag- netic resonance imaging. Otolaryngol Head Neck Surg 1999;120:517-23.
• Lildholdt T, Rundcrantz H, Lindqvist N. Efficacy of topical corticosteroid powder for nasal polyps: a dou- ble-blind, placebo-controlled study of budesonide. Clin Otolaryngol 1995;20:26-30.
• Mygind N. Topical steroid treatment for allerg i c rhinitis and allied conditions. Clin Otolaryngol 1982;7 : 3 4 3 - 5 2 .
• van Camp C, Clement PA. Results of oral steroid treat- ment in nasal polyposis. Rhinology 1994;32:5-9.
• Mygind N. Advances in the medical treatment of nasal polyps. Allergy 1999;54 Suppl 53:12-6.
• Mygind N. Effects of corticosteroid therapy in non-aller- gic rhinosinusitis. Acta Otolaryngol 1996;11 6 : 1 6 4 - 6 .
• Drake-Lee AB. Medical treatment of nasal polyps. Rhinology 1994;32:1-4.
• Drake-Lee AB, McLaughlan P. Clinical symptoms, free histamine and IgE in patients with nasal polyposis. Int Arch Allergy Appl Immunol 1982;69:268-71.
• Drake-Lee AB. The value of medical treatment in nasal polyps. Clin Otolaryngol 1991;16:237-9.