Nose and paranasal sinusesChronic rhinosinusitis and eosinophils: do macrolides have an effect?Wallwork, Bena; Coman, Williamb Author Information aSchool of Biomolecular and Biomedical Science, Griffith University, Brisbane, Australia, and bDepartment of Oto-Rhino-Laryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Australia Correspondence to Ben Wallwork, MD, Gold Coast Hospital, 108 Nerang Street, Southport Q1d, Australia 4217 E-mail: [email protected] Current Opinion in Otolaryngology & Head and Neck Surgery: February 2004 - Volume 12 - Issue 1 - p 14-17 Buy Abstract Purpose of review Long-term, low-dose macrolide therapy is effective in the treatment of chronic airway inflammation. It is believed that macrolide antibiotics produce this benefit through an antiinflammatory effect that is separate from their antibiotic effect. Eosinophils are key mediators in the inflammation seen in chronic rhinosinusitis. This review discusses the effect of macrolides on eosinophilic inflammation. Recent findings In vitro studies recently have suggested that macrolides increase eosinophil apoptosis and reduce production of eosinophil chemotactic cytokines and adhesion molecules. In vivo studies have shown a reduction in eosinophil count and activity in asthma and chronic rhinosinusitis. Clinical response to macrolide treatment is thought to be less likely in patients with atopy. Summary In contrast to the evidence supporting the effect of macrolides on neutrophilic inflammation, there are limited data to suggest an influence on eosinophilic inflammation. For this reason, patients with prominent eosinophilic inflammation may in the future be identified as being less likely to respond to treatment. Further in vitro and clinical studies are required to investigate this subject. © 2004 Lippincott Williams & Wilkins, Inc.