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Levofloxacin in Bacterial Rhinosinussitis (Levolet)

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT02712502
First Posted: March 18, 2016
Last Update Posted: March 18, 2016
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Information provided by (Responsible Party):
Dr. Reddy's Laboratories Limited
  Purpose

Inflammatory paranasal diseases are among the most common diseases in ENT In Russia, puncture method has been conventional approach to treatment of maxillary sinusitis. However, this procedure is associated with a number of drawbacks A promising trend for the treatment of purulent sinusitis is a reasonable antibacterial therapy Fluoroquinolones, particularly levofloxacin, are highly active against pneumonocci and are more active vs. the drug products of the second generation against intracellular agents (Chlamydia spp., Mycoplasma spp., M. tuberculosis, rapidly growing atypical mycobacteria (M. avium, etc.).

Due to high activity against the agents causing bacterial upper and lower respiratory tract infections they are sometimes called "respiratory" fluoroquinolones


Condition Intervention
Rhinosinusitis Drug: Levofloxacin Drug: Amoxicillin-Potassium Clavulanate Combination

Study Type: Observational
Study Design: Observational Model: Case Control
Time Perspective: Prospective
Official Title: Open-label Comparative Safety and Efficacy Study of Levofloxacin and Amoxicillin Clavulanic Acid in Patients With Acute ,Bacterial Rhinosinusitis

Resource links provided by NLM:


Further study details as provided by Dr. Reddy's Laboratories Limited:

Primary Outcome Measures:
  • Reduction in mean value of Visual Analogue Scale after Levolet R therapy. TOLERABILITY of the treatment is assessed by the subjects using 10-point scale [ Time Frame: 10 days ]
    Dynamics of clinical symptoms (patient assessment) disease independently evaluate patients on a 10-point system (visual analogue scale - VAS), where: 0 - no symptom, 10 points - a symptom of painful, as you can imagine.


Secondary Outcome Measures:
  • Physician's assessment: Changes in clinical symptoms using 4-point scale [ Time Frame: 10 days ]
    • Dynamics of clinical symptoms (score doctor) was evaluated by a doctor of 4-point scale, where "0" - the absence of symptoms, "1" - easy to severe symptoms, "2" - moderately severe symptoms, "3" - severe symptoms.

  • The final evaluation of the effectiveness of treatment on [ Time Frame: 10 days ]
    • "Excellent" - a significant reduction of symptoms, improvement in instrumental studies;
    • "Good" - the improvement of health, regression of symptoms, a positive trend data of laboratory and instrumental studies.
    • "satisfactory" - a slight improvement in the general condition and moderately positive dynamics of laboratory and instrumental studies.
    • "The lack of effect" - the absence of the dynamics of all symptoms, indicators of laboratory and instrumental studies, as well as when it is impossible to evaluate the effect, in the case of cessation of treatment.
    • "Deterioration" - weighting of the general condition and the negative dynamics of the indices of laboratory and instrumental studies, the need for additional treatment.

    Tolerability independently assessed patients, 10 point system, where "0" - no side effects, "10" - the inevitable need for the drug.



Enrollment: 100
Study Start Date: September 2014
Study Completion Date: December 2014
Primary Completion Date: December 2014 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Study group (OG).

50 patients c and acute exacerbation of chronic bacterial rhinosinusitis in the study group (OG).

The treatment regimen in the study group.

  • Levofloxacin (Levolet) 750 mg (500 mg Levolet P + P Levolet 250 mg) 1 times a day. The course of treatment is 5 days.
  • Decongestants: xylometazoline 2 doses in each nostril two times daily - the first 5 days, then if necessary.
Drug: Levofloxacin
  • Levofloxacin (Levolet) 750 mg (500 mg Levolet P + P Levolet 250 mg) 1 times a day. The course of treatment is 5 days.
  • Decongestants: xylometazoline 2 doses in each nostril two times daily - the first 5 days, then if necessary.
Other Name: Levolet P500, Levolet P 250
Control group (CG).

50 patients c and acute exacerbation of chronic rhinosinusitis in the control group (CG).

The treatment regimen of the control group. Amoxicillin-Potassium Clavulanate Combination (875 mg of amoxicillin trihydrate, potassium clavulanate salt + 125 mg), 2 times a day. The course of treatment 10 days.

• Decongestants: xylometazoline 2 doses in each nostril two times daily - the first 5 days, then if necessary.

Drug: Amoxicillin-Potassium Clavulanate Combination

Amoxicillin-Potassium Clavulanate Combination (875 mg of amoxicillin trihydrate, potassium clavulanate salt + 125 mg), 2 times a day. The course of treatment 10 days.

• Decongestants: xylometazoline 2 doses in each nostril two times daily - the first 5 days, then if necessary.

Other Name: Amoxiclav

Detailed Description:

Inflammatory diseases of paranasal sinuses occupy one of the leading positions in the overall structure of ENT-diseases.

Puncture method has been a conventional approach to the treatment of suppurative maxillary sinusitis in Russia until present. However, this relatively simple and conventional treatment method has a number of disadvantages. Fear of an unpleasant procedure is justified. Generally, single puncture does not ensure healing, and the doctor has to install drainage or of perform repeated manipulations significantly reducing quality of life during the disease period. There is also a certain risk of puncture needle penetration into adjacent areas. Sometimes direct contraindications to punctures exist (intolerance of topical anesthetics, blood clotting disorders, etc.).

The puncture itself, as an independent method, is a relieving procedure rather than a pathognomonic treatment method, especially regarding severe combined forms of sinusitis with risk of intracranial complications. Due to lacking standardized antibacterial drugs to be injected into the sinus, multiple punctures are erroneously considered to be able of eliminating the bacterial agent successfully.

One of the promising trends regarding the treatment of suppurative maxillary sinusitis is an adequate antibacterial therapy. Fluoroquinolones of last generations, levofloxacin in particular, which are highly active against pneumococci, are more effective vs. generation II drugs against intracellular agents (Chlamydia spp., Mycoplasma spp., M.tuberculosis, rapidly growing atypical mycobacteria (M.avium, etc.). At that activity towards other gram-negative bacteria is not reduced. An important property of these drugs consists in activity regarding a number of bacteria resistant to generation II fluoroquinolones. Due to high activity against the agents of upper and lower respiratory bacterial infections they are sometimes called "respiratory" fluoroquinolones.

According to a publication, Levofloxacin 500 mg q.d. for 5 days eliminated radiological signs of the disease by the end of the course in 65% subjects, while 35% showed positive changes only (М.А. Panyakina, 2012). Based on these findings, otolaryngologists have to obtain higher therapeutic efficacy levels with the same 5-day course, since this treatment term demonstrates violated compliance most frequently. One of the options is an elevation of daily dose. In particular, Rameez Shah (2013) published data concerning high efficacy of levofloxacin at a daily dose of 750 mg for 5 days.

Necessity to search ways to shorten the current course of antibiotic therapy is being under discussion at all levels. Particularly, 24th European Congress of Clinical Microbiology and Infectious Diseases performed on May 10-13, 2014 in Barcelona (ECCMID 2014) repeatedly raised question concerning revision of the current treatment standards and clinical recommendations concerning duration of antibiotic therapy and dosing regimens.

Based on the above-mentioned findings, it would be interesting to evaluate efficacy of various antibiotic schemes (respiratory fluoroquinolones or protected aminopenicillin) in hospital conditions.

  Eligibility

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Ages Eligible for Study:   18 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

100 Subjects with chronic bacterial rhinosinusitis were included in study. 50 subjects with acute and aggravated chronic bacterial rhinosinusitis in the main group (subjects receiving levofloxacin (Levolet® R)

50 subjects with acute and aggravated chronic bacterial rhinosinusitis in the control group (subjects receiving levoflamoxicillin clavulanate)

Criteria

Inclusion Criteria:

  • Signed informed consent form.
  • Males and females aged 18-60 years old
  • Hospitalized subjects with verified diagnosis of moderate/severe acute bacterial rhinosinusitis
  • Readiness to comply with medical recommendations.
  • Assessment of objective and subjective symptoms of the disease >= 3 points

Exclusion Criteria:

  • Previous nasal surgery within the last 6 months
  • Participation in other studies
  • Polypous rhinosinusitis
  • Concomitant therapy affecting the study results (psychotropic drugs, alpha-adrenoreceptor antagonists, antihistamine drug, antibiotics, cromones, corticosteroids) within the last month
  • Need in cromones, antihistamine drugs, corticosteroids (moderate and severe allergic rhinitis)
  • Severe somatic diseases in the past medical history: severe endocrine pathologies, severe cardiovascular diseases, renal and/or hepatic failure, oncology
  • Subject's inability to perceive instructions for the study procedure
  • Pregnancy, lactation
  • Signs of a dangerous infectious disease.
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02712502


Sponsors and Collaborators
Dr. Reddy's Laboratories Limited
Investigators
Principal Investigator: A Y Ovchinnikov Head of the Department Diseases of the ear, nose and throat ,Moscow State Medical Dental University of the Ministry of Health of Russia, Otorhinolaryngology Department of Postgraduate Studies Faculty
  More Information

Responsible Party: Dr. Reddy's Laboratories Limited
ClinicalTrials.gov Identifier: NCT02712502     History of Changes
Other Study ID Numbers: DRL_RUS/MD/2014/PMS/Levolet
First Submitted: March 14, 2016
First Posted: March 18, 2016
Last Update Posted: March 18, 2016
Last Verified: November 2014
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Additional relevant MeSH terms:
Sinusitis
Paranasal Sinus Diseases
Nose Diseases
Respiratory Tract Diseases
Respiratory Tract Infections
Otorhinolaryngologic Diseases
Amoxicillin
Levofloxacin
Ofloxacin
Clavulanic Acid
Clavulanic Acids
Amoxicillin-Potassium Clavulanate Combination
Nasal Decongestants
Pseudoephedrine
Xylometazoline
Ephedrine
Anti-Bacterial Agents
Anti-Infective Agents
Anti-Infective Agents, Urinary
Renal Agents
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Cytochrome P-450 CYP1A2 Inhibitors
Cytochrome P-450 Enzyme Inhibitors
beta-Lactamase Inhibitors
Vasoconstrictor Agents
Respiratory System Agents