What is it about?
The results of a large trial comparing treatments for chronic rhinosinusitis (CRS) have recently been published in the Lancet https://doi.org/10.1016/S0140-6736(25)01248-6. CRS is a common condition affecting up to 10% of adults, leading to symptoms including nasal obstruction, discharge, loss of sense of smell, and facial pain. The main aim of the trial was to compare the benefit of endoscopic sinus surgery (ESS), with that of an antibiotic (clarithromycin) to treat CRS. Both of these treatments are currently offered to patients with CRS with or without nasal polyps. This is when the “standard” nasal treatments of salt water rinsing and nasal steroid sprays/drops have not improved symptoms. There was previously limited evidence of whether these treatments worked. Because of this, there are significant differences across the UK as to which are offered to patients. This trial shows very clearly that ESS improves symptoms significantly. The antibiotic treatment did not show any clear benefit compared to placebo (a dummy tablet with no active medicine). ESS is therefore recommended as the next treatment for most CRS patients when “standard” treatment alone has not helped.
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Why is it important?
In adult patients with CRS who have failed to achieve good control of their symptoms after using intranasal steroid based medications and salt water rinses, surgery should be considered and will likely be beneficial. In contrast, long term macrolide antibiotics should not be used routinely in these patients. There may be a small number of carefully selected patients where this treatment is still offered.
Perspectives
This is the first trial internationally to definitively show that sinus surgery improves patient outcomes when intranasal medical therapy alone has not helped.
Professor Carl Philpott
University of East Anglia
Read the Original
This page is a summary of: The clinical effectiveness of clarithromycin versus endoscopic sinus surgery for adults with chronic rhinosinusitis with and without nasal polyps (MACRO): a pragmatic, multicentre, three-arm, randomised, placebo-controlled phase 4 trial, The Lancet, August 2025, Elsevier,
DOI: 10.1016/s0140-6736(25)01248-6.
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