The Role of Macrolides and Doxycycline in Chronic Rhinosinusitis

Katherine A. Lees, Richard R. Orlandi, Gretchen Oakley, Jeremiah A. Alt

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Antibiotic therapy has become an important adjunct in the management of recalcitrant chronic rhinosinusitis (CRS) because of some antibiotics’ immunomodulatory properties even at subtherapeutic antimicrobial levels. Macrolide antibiotics, such as clarithromycin and azithromycin, decrease production of proinflammatory cytokines, impair neutrophil recruitment, inhibit bacterial biofilm formation, and improve mucus quality. Doxycycline, a tetracycline antibiotic, inhibits the activity of matrix metalloproteinases in CRS with nasal polyposis. This article reviews the clinical applications for macrolide and doxycycline use in CRS, considerations for dosing and duration of treatment, and important side effects and drug interactions associated with these medications.

Original languageEnglish (US)
Pages (from-to)303-315
Number of pages13
JournalImmunology and Allergy Clinics of North America
Issue number2
StatePublished - May 2020
Externally publishedYes


  • Chronic
  • Doxycycline
  • Immunomodulation
  • Macrolides
  • Polyps
  • Rhinosinusitis
  • Sinusitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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