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Small-dose, long-term therapy using macrolide antibiotics has been recently established as a medical treatment for chronic sinusitis in adults and children. This therapy has been reported to be highly effective, but problems related to the development of drug-resistant bacteria often long-term administration are now appearing. In the present study, we used small-dose macrolide therapy for the treatment of pediatric chronic sinusitis and examined the clinical efficacy, changes in detected bacteria with time, drug sensitivity and the presence of resistance genes from a bacteriological viewpoint. The subjects consisted of 13 children with pediatric chronic sinusitis who were treated at the Department of Otorhinolaryngology in Omori Hospital, Toho University, and at related hospitals between June 2001 and March 2002. Three kids of bacteria, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, were detected in the middle nasal meatus of these subjects. Patients with chronic pediatric sinusitis were treated with 5-7.5mg/kg of clarithromycin (brand name, Clarith) for one month or longer, and the clinical efficacy of the treatments was evaluated using intranasal findings and X-ray findings before and after the administration of clarithromycin. The presence of bacteria in the middle nasal meatus was examined once a week. When S. pneumoniae, H. influenzae or M. catarrhalis was detected at least twice in one patient, the bacteria was isolated; its drug sensitivity was then examined and an epidemiological study was performed using genetic methods. No correlations between the isolated bacteria and clarithromycin sensitivity were found, and small-dose macrolide therapy proved to be clinically effective. Clarithromycin had little effect on the sensitivity of the detected bacteria to various drugs over time.

Examination of Bacteria Detected in the Middle Meatus of Children with Chronic Sinusitis Receiving Small Doses of Macrolides Over a Long Period