Doxycycline for Recurrent Chronic Rhinosinusitis with Nasal Polyps

Objectives:Evaluate factors related to improvement after doxycycline treatment for patients with recurrent chronic rhinosinusitis with nasal polyps.Methods:We conducted an open label study from 2012 to 2013 on 32 patients with difficult‐to‐treat chronic rhinosinusitis with nasal polyps uncontrolled after endoscopic sinus surgery and long‐term low‐dose clarithromycin treatment. Patients received doxycycline 100mg per day for 12 weeks after a three‐month wash‐out period. The main outcome measure was a meaningful improvement in SNOT‐20 (>0.80). Other outcome measures were the SNOT‐20, NOSE, and Lund‐Kennedy scores. The following parameters were analyzed: asthma, rhinitis, DREA, and blood testing before treatment for C3, C4, IgG, IgA, IgE, IgM, ANCA, and blood eosinophil count.Results:53.1% (17/32) of patients showed a clinically significant improvement in SNOT‐20 (>0.8) score after treatment. The patients also showed a statistically significant improvement in SNOT‐20 (p<0.001), Lund‐Kennedy (p<0.001), and NOSE (p<0.004) scores. Presence of asthma (p<0.001), AERD (p<0.008), increased level of blood eosinophil count, and increased serum IgE (p<0.018) were factors associated with a worse prognosis after treatment.Conclusions:Our group of patients showed a positive result after treatment with doxycycline, especially in patients without asthma, DREA, andincreased serum levels of IgE and eosinophil counts.