Objective  To systematically evaluate the efficacy and safety of long-term low-dose clarithromycin in the treatment of chronic rhinosinusitis (CRS).

Methods  Randomized controlled trials (RCTs) of low-dose clarithromycin for CRS were collected from CNKI, WanFang, VIP, PubMed, Embase, Web of Science, The Cochrane Library databases, and the clinical trial registration platform from database inception to January 21, 2025. Meta-analysis was performed by RevMan 5.4.1 software.

Results  A total of 31 RCTs were included. The treatment group showed superior results compared to the control group in terms of overall effectiveness [OR=4.31, 95%CI (3.30, 5.63)], SNOT-20 scores [MD=-1.64, 95%CI (-3.20, -0.08)], Lund-Kennedy scores [MD=-1.17, 95%CI (-1.55, -0.79)], Lund- Mackay score [MD=-1.38, 95%CI (-1.84, -0.92)], and VAS scores [MD=-1.11, 95%CI (-1.50, -0.72)], with statistically significant differences (P<0.05). However, there was no statistically significant difference between the two groups in terms of adverse event rate [OR=1.12, 95%CI (0.74, 1.70)] and recurrence rate [OR=0.73, 95%CI (0.39, 1.37)] (P>0.05).

Conclusion  Current evidence suggests that long-term low-dose clarithromycin treatment for CRS has good clinical efficacy, though further validation through high-quality, large-scale RCTs remains necessary.

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