Maniakas A, Asmar MH, Renteria AE, et al. - In this double‐blind, randomized, placebo‐controlled trial, researchers tested the effectiveness of low‐dose, long‐term azithromycin in a carefully selected high‐risk population failing appropriate medical therapy of budesonide nasal irrigations (BNIs) and endoscopic sinus surgery (ESS). This trial was completed in a single tertiary‐care center evaluating the addition of 250 mg azithromycin, 3 times per week for 16 weeks, in adults failing ESS and high‐volume BNIs. In total, 128 patients were recruited and underwent ESS followed by BNI. Forty-eight patients exhibited disease persistence and were randomized to azithromycin or placebo at the 4‐month post‐ESS visit. Azithromycin is a low-dose therapeutic alternative with few side effects. Its use in this difficult-to-treat population can show favourable clinical results, particularly if patients are aspirin‐exacerbated respiratory disease-negative.