Evaluation of the Efficacy of Azithromycin in Idiopathic Purulent Oedematous Sinusitis in Adults
Evaluation of the Efficacy of 3-month Continuous Extended Treatment With Azithromycin in Idiopathic Purulent Oedematous Sinusitis in Adults: a Multicentre Randomised Controlled Trial
Centre Hospitalier Intercommunal Creteil
230 participants
Nov 21, 2022
INTERVENTIONAL
Conditions
Summary
Purulent Oedematous Sinusitis (POS) is a particular form of chronic rhinosinusitis observed in 2% of the general population. In spite of its heavy impact on the quality of life, There is no established recommendation for the treatment of primary POS. Long-term low-dose macrolides are currently proposed for these forms of chronic rhinosinusitis when conventional treatments (local corticosteroids, saline rinsing, iterative short courses of antibiotics targeted on pathogens, and surgical opening and drainage) have failed. This treatment with macrolides is currently applied off-label. This study aims to assess the efficacy of macrolides in POS. An extensive workup is fulfilled to exclude other forms of chronic rhinosinusitis (Th2 biased inflammatory diseases, allergic diseases) (allergy, nasosinusal polyposis) or those due to cystic fibrosis or immune deficiency.
Eligibility
Inclusion Criteria20
- Patient older than 18 years and less than 70 years of age
- Chronic rhinosinusitis (\> 12 weeks of evolution) meeting the definition published in the European Paper Position2012 (1) and corresponding exclusively to the following endoscopic and CT criteria:
- Nasal endoscopy showing bilateral and diffuse involvement associating edema of the mucosa of the nasal cavities and meatus with the presence of mucopurulent secretions in these areas
- Nasosinus CT scan showing diffuse and bilateral pansinus opacities involving at least the maxillary sinuses and the anterior and posterior ethmoids
- Persistent intractable purulent rhinosinusitis despite at least 2 antibiotic therapies
- Signed informed consent of the patient
- Membership in a health insurance plan or beneficiary
- Atorvastatin (Increased risk of concentration-dependent rhabdomyolysis-type adverse events due to decreased hepatic metabolism of the cholesterol-lowering drug.
- Ciclosporin (risk of increased ciclosporin blood levels and creatinine levels)
- Digoxin (increase in digoxemia due to increased absorption of digoxin), Drugs likely to cause torsades de pointes, in particular class IA (e.g. quinidine) and class III (e.g. amiodarone, sotalol) antiarrhythmics, antipsychotics (e.g. phenothiazines, pimozide), tricyclic antidepressants (e.g. citalopram), certain fluoroquinolones (e.g. moxifloxacin, levofloxacin) (increased risk of ventricular rhythm disturbances)
- Simvastatin (increased risk of rhabdomyolysis-type adverse effects (concentration-dependent), due to decreased hepatic metabolism of the cholesterol-lowering agent)
- Ivabradine (increased risk of ventricular rhythm disorders),
- Hypokalemic drugs
- Bradycardia drugs
- Patients with severe cholestasis
- Patients under guardianship or curatorship
- Patients with hematologic malignancies who have undergone hematopoietic stem cell transplantation
- History of facial radiotherapy
- History of rhinosinus cancer
- Participation in other category 1 research at the time of inclusion or in the month prior to inclusion
Exclusion Criteria18
- Pregnancy or breastfeeding
- PCOS of identified primary cause (identified immune deficiency, cystic fibrosis, HIV)
- Chronic non-purulent rhinosinusitis (nasosinusal polyposis, allergic rhinosinusitis)
- Localized chronic suppurative rhinosinusitis (single sinus, unilateral, frontal or maxillary or sphenoidal)
- Severe hepatic insufficiency (factor V level \< 50%)
- Severe renal insufficiency (stage 4 (GFR \< 30 ml/min/1.73 m2) and/or creatinine \< 40 ml/min)
- Severe heart failure (old age, ischemic heart disease, episode of recurrent cardiac arrest; hypotension, NYHA functional stage III-IV; widened QRS, complex ventricular arrhythmias; hyponatremia (Na \<135mmol/l); stage 4 renal failure (GFR \< 30 ml/min/1.73 m2); severely depressed LVEF (\< 30%)
- Documented moderate pre-existing sensorineural hearing loss with a mean pure tone threshold in the poorer ear in bone conduction \>30 dB across all 3 frequencies (500, 1000 and 2000 Hz) or in only one ear (unilateral deafness).
- Major cognitive impairment or lack of French language skills preventing completion of SNOT-22 and SF-36 questionnaires
- Patient with galactose intolerance, total lactase deficiency or glucose-galactose malabsorption syndrome (rare hereditary diseases)
- Patient with peanut or soy allergy
- Patient allergic to macrolides
- Patients who are intolerant or allergic to any of the excipients of azithromycin or placebo
- Treatment with azithromycin in the previous 3 months
- Long QT on ECG ((\>440ms for male and \>450ms for female) or cardiac arrhythmia or bradycardia (\<60btm).The calculation of the corrected QT should be carried out using the Bazett formula.
- Hypokalemia or hypomagnesemia on blood ionogram
- Confirmed or suspected atypical mycobacteriosis
- Contraindicated drug combinations with macrolides (K-vitamins or drugs containing cisapride, colchicine, ergotamine or dihydroergotamine)
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Interventions
Treatment assigned by randomization will be prescribed immediately. The active or placebo will be dispensed by the centre's pharmacy. Treatment will be taken in the morning or evening for 3 months.
Treatment assigned by randomization will be prescribed immediately. The active or placebo will be dispensed by the centre's pharmacy. Treatment will be taken in the morning or evening for 3 months.
Locations(13)
View Full Details on ClinicalTrials.gov
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NCT05157685