2. Table of Contents
Clarithromycin
Brief explanation about
clarithromycin
Chronic Rhinosinusitis
Brief explanation about
chronic rhinosinusitis
Treatment
Brief explanation about
chronic rhinosinusitis
treatment
Clarithromycin and CRS
Role of clarithromycin in
CRS treatment
01
03
02
04
4. Chronic Rhinosinusitis
Chronic Rhinosinusitis (CRS) is a sudden onset of two or
more symptoms, one of which should be either nasal
blockage/obstruction/congestion or nasal discharge
(anterior/posterior nasal drip) with or without facial
pain/pressure, with or without reduction or loss of smell
for > 12 weeks
5. DEFINITION
Inflammation on nasal & paranasal sinuses
mucosa with at least consists of two following
simptoms :
A. Obligate symptoms (at least one):
• nasal blockage/obstruction/congestion
• anterior/posterior nasal discharge
B. Additional symptom:
• Facial pain/fullness
• Reduced smell
Additional finding on NE:
• Mucopurulent discharge in the middle
meatal
• Mucosal edema
Additional finding on CT:
• Paranasal sinus(es) opacity/ mucosal
thickening.
Fokkens WJ, Lund VJ, Hopkins C, Hellings P.W, Kern R, Reitsma S., et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020 Suppl 29:1-464.
CDC. Sinus Infection. Available in: https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/sinus-infection.html. Accessed October 26th 2020.
8. ‘Appropriate medical
therapy’ is the
preferred option of the
EPOS 2020 steering
group
MANAGEMENT
For diffuse, bilateral
CRS, local
corticosteroids and
saline remain the
mainstay of the
treatment
If treatment with nasal
steroid and saline is
insufficient, an
additional work-up
with CT scan and
endotyping is relevant
The integrated care
pathway (ICP) advises
to check treatable
traits, to avoid
exacerbating factors
11. RECOMMENDATION
have a positive impact
on disease specific and
general QOL in
patients with CRS.
Long term treatment is
effective and safe
significant reduction
in total symptom
score and nasal polyp
score in patients with
CRSwNP
Nasal irrigation
with isotonic saline
or Ringer’s lactate
is an effective
treatment in CRS
patients.
uncertain whether
or not the use of
antibiotics has an
impact on patient
outcomes in adults
with CRS
NASAL
CORTICOSTEROIDS
SHORT COURSE
SYSTEMIC
CORTICOSTEROID
NASAL
IRRIGATION
ANTIBIOTICS
with or without local corticosteroid
short course and long term
12. RECOMMENDATION
EPOS2020 steering
group suggests in
general not to use
nasal decongestants
in CRS.
There is insufficient
evidence on the effect
of the regular use of
antihistamines in the
treatment of patients
with CRS.
does not seem to be
more effective than
placebo in improving
symptoms in patients
with CRS.
continuing nasal
corticosteroid sprays for
CRS maintenance,
using pregnancy-safe
antibiotics for acute
rhinosinusitis and CRS
exacerbations,
discontinuing aspirin
desensitization
DECONGESTANT ANTIHISTAMINE
TOPICAL
ANTIBACTERIAL
PREGNANCY
In situations where the nose is very
blocked, the temporary addition of a
nasal decongestant to the nasal
corticosteroid treatment can be
considered.
Non-relevant improvement in
symptoms, SNOT-22 and LK
endoscopic score compared to
oral antibiotics.
15. Macrolides
(eg. clarithromycin and azithromycin, etc.)
have gained initial popularity in the
treatment of CRS due to their anti-
inflammatory, anti-biofilm and
immunomodulatory effect
Editor's Notes
Peradangan pada sinus hidung & paranasal mukosa dengan setidaknya terdiri dari dua gejala berikut:
Gejala wajib (setidaknya satu):
-penyumbatan / obstruksi / hidung tersumbat
-sekret hidung anterior / posterior
B. Gejala tambahan:
-Nyeri wajah / penuh
-Bau berkurang
Temuan tambahan di NE:
-Keluarnya sekret mukopurulen di bagian middle meatal
-Edema mukosa
Temuan tambahan pada CT:
-Opasitas / penebalan mukosa sinus paranasal.
