I have been on low dose macrolides ever since I stumbled across Anders
Cervin's article in 2002. There are many articles in the literature,
and a very good summary in Chest that I have previously posted.
 There was a recent double blinded study by Cervin et al, and it
showed benefit, but you need to select the patients carefully:
ironically those with low  IbE levels tend to respond best.
 Although Cervin's original article only used the macrolides for a
year, by ENT and I decided to use it as long as it has remained
effective, and the results of biaxin 250 mg/day have been superb.
 The literature has articles on erythromycin, biaxin, roxithromycin
(not in US). In cystic fibrosis, they use pulses of azithromycin with
excellent results to try and prevent intractable pseudomonas.
Macrolides have been used in panbronchiolitis in Japan for years.
 My ENT attends national meetings and brings up the subject regularly
to nationally reguarded ENT's and finds universal ignorance of the
subject. I brought it up to a doctor at Lahey Clinic, and he was much
more interested in surgery with the sinus balloon, and stated that
macrolides have been "disappointing".
 My ENT is planning a grand rounds at the major teaching hospital at
Brown to bring the community up to speed. I've sent him most of the
articles I keep on my computer.
 He started using zithromax at 250mg once or twice a week, for
compliance, and has about 10 patients on it with good results.
 I've used biaxin 250 mg/day since 2002 with dramatic results. My
older daughter started it this year when we discovered an IgA
deficiency and she had an intractable sinusitis: it's also an excellent
drug for her asthma. My younger daughter who had a very rough time with
migraine disease and migraine associated vertigo and had a persistant
sinusitis (no immune deficiency in her workup) could only take
zithromax due to drug interactions, and she's been on it for two months
with good results. Per the recent comment posted by Dr. Ferguson (in
response to an article on irrigation) from Pittsburgh, patients with
chronic sinusitis have a higher percentage of a gene mutation similar
to cystic fibrosis and I'm sure that's what's behind the strong family
history of sinusitis in my family (my sisters have sinus issues as
well.)
 I have an IgG subtype deficiency, and my allergist sent a similar
patient to Boston for eval, and low dose macrolides were recommended.
 I do get some push-back from my internist, she's worried about
resistance. The Chest article has stated that resistance has not been a
major issue. I've heard that there are drugs in the pipeline where they
have the anti-inflammatory component, but no anti-microbial activity.
Ironically, we put patients with acne or rosacea on macrolides for
years without fretting about resistance.
 My husband is a dentist and they've used very low dose doxycycline:
20 mg twice a day, for years for gum disease. Recently 40 mg
doxycycline was just approved for rosacea.
 So, in summary: I've had sinus disease for decades, had 5 surgeries,
have a primary immunodeficiency and allergies--although I DO have low
IgE levels--and 4 years of low dose biaxin has been clinically
wonderful for me. I met the initial criteria of patients who failed
surgery and have low IgE levels. I take it every day.
 It's like you don't want to draw the evil eye, but prior to biaxin I
had either a constant infection or at least 6/year. My last infection
was over a year ago. There have been studies done in Japan on patients
on macrolides and they get less colds, due to the mechanism of not
allowing adherence, so I think that's helped a lot as well as I work in
medicine and get coughed on a lot.
Judy

I think it is the European place.