{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T18:46:20Z","timestamp":1760985980642,"version":"3.40.5"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,9,15]],"date-time":"2020-09-15T00:00:00Z","timestamp":1600128000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000156","name":"Fonds de Recherche du Qu\u00e9bec - Sant\u00e9","doi-asserted-by":"publisher","award":["32455"],"award-info":[{"award-number":["32455"]}],"id":[{"id":"10.13039\/501100000156","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["RN373684\u2010414953"],"award-info":[{"award-number":["RN373684\u2010414953"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Refractory chronic rhinosinusitis (CRS) remains a significant burden for patients, often leaving them with few therapeutic options that provide low\u2010morbidity, long\u2010term, and meaningful symptomatologic and endoscopic disease improvement. Macrolides have long been thought to offer both an immunomodulatory and antimicrobial effect. Our objective was to evaluate the efficacy of low\u2010dose, long\u2010term azithromycin in a carefully selected high\u2010risk population failing appropriate medical therapy of budesonide nasal irrigations (BNIs) and endoscopic sinus surgery (ESS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A double\u2010blind, randomized, placebo\u2010controlled trial was completed in a single tertiary\u2010care center assessing the addition of 250 mg azithromycin, 3 times per week for 16 weeks, in adults failing ESS and high\u2010volume BNIs. Associated comorbidities, as well as symptomatologic, microbiologic, and serologic values, were systematically collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 128 patients were enrolled and underwent ESS followed by BNI. At the 4\u2010month post\u2010ESS visit, 48 patients showed disease persistence and were randomized to azithromycin or placebo. Overall, azithromycin, when compared with placebo, did not show a statistically significant difference in disease clearance (54% vs 33%, respectively; <jats:italic>p<\/jats:italic> = 0.146), although patients with disease clearance who were on azithromycin showed significantly better 22\u2010item Sino\u2010Nasal Outcome Test score improvements than patients on placebo (18 vs \u22120.9, respectively; <jats:italic>p<\/jats:italic> = 0.046). In a subgroup analysis excluding aspirin\u2010exacerbated respiratory disease (AERD) patients, azithromycin significantly improved disease clearance when compared with placebo (71% vs 35%, respectively; <jats:italic>p<\/jats:italic> = 0.031), with a number needed to treat of 3 (2.8).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Low\u2010dose azithromycin is a therapeutic option with few side effects. Its use can show favorable clinical outcomes in this difficult\u2010to\u2010treat population, especially if patients are AERD\u2010negative.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22691","type":"journal-article","created":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T13:00:50Z","timestamp":1600952450000},"page":"747-754","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Azithromycin in high\u2010risk, refractory chronic rhinosinusitus after endoscopic sinus surgery and corticosteroid irrigations: a double\u2010blind, randomized, placebo\u2010controlled trial"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4354-2841","authenticated-orcid":false,"given":"Anastasios","family":"Maniakas","sequence":"first","affiliation":[{"name":"Centre de Recherche du Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Division of Otolaryngology\u2012Head &amp; Neck Surgery Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Division of Experimental Surgery McGill University  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Division of Otolaryngology\u2012Head &amp; Neck Surgery H\u00f4pital Maisonneuve\u2010Rosemont  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc\u2010Henri","family":"Asmar","sequence":"additional","affiliation":[{"name":"Centre de Recherche du Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3180-3047","authenticated-orcid":false,"given":"Axel Eluid","family":"Renteria","sequence":"additional","affiliation":[{"name":"Centre de Recherche du Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Division of Otolaryngology\u2012Head &amp; Neck Surgery Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Smriti","family":"Nayan","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2012Head &amp; Neck Surgery McMaster University  Hamilton Ontario Canada"},{"name":"Department of Surgery Cambridge Memorial Hospital  Cambridge Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saud","family":"Alromaih","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2012Head &amp; Neck Surgery Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Faculty of Medicine King Saud University  Riyadh Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leandra Mfuna","family":"Endam","sequence":"additional","affiliation":[{"name":"Centre de Recherche du Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Sam","family":"Sampalis","sequence":"additional","affiliation":[{"name":"Division of Experimental Surgery McGill University  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Medical Affairs JSS Medical Research  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Desrosiers","sequence":"additional","affiliation":[{"name":"Centre de Recherche du Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Division of Otolaryngology\u2012Head &amp; 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