Clinical Trial to Reconfirm the Efficacy and Safety of Cefetamet Pivoxil Treatment in Sinusitis Patients: A Double-Blind, Randomized, Parallel Designed, Multicenter, Active Comparator Study (CASIS Study)

OBJECTIVE

To evaluate the clinical efficacy and safety of cefetamet pivoxil for the treatment of acute bacterial rhinosinusitis in Korean patients compared to treatment with cefdinir.

METHODS

A prospective, multicenter, randomized double-blind, comparative study was conducted by the Departments of Otorhinolaryngology-Head and Neck Surgery at 17 hospitals or universities in the Republic of Korea from March 2017 to April 2019. A total of 309 patients were screened and 249 patients participated in the study.

RESULTS

Treatment with cefetamet pivoxil for 2 weeks showed 82.4% clinical cure and improvement rates in patients with acute bacterial rhinosinusitis compared to 84.68% in those taking cefdinir for 2 weeks, showing that cefetamet pivoxil administered twice a day for 2 weeks was as effective as cefdinir 3 times a day for 2 weeks for the treatment of acute bacterial rhinosinusitis. The overall adverse reaction rates of both drugs were 10.56% in the cefetamet pivoxil group and 15.49% in the cefdinir group, without serious adverse events or drug reactions.

CONCLUSIONS

Cefetamet pivoxil twice a day was as efficacious and safe as cefdinir 3 times a day for the treatment of acute bacterial rhinosinusitis, which suggested that cefetamet pivoxil may be a suitable alternative to cefdinir.

[An analysis of experience of using nasal catheters in acute bacterial rhinosinusitis]

The number of cases of acute bacterial rhinosinusitis (ABRS) in our country tends to increase. According to clinical guidelines of the Ministry of Health of the Russian Federation, nasal catheter drainage is used to treat ABRS, but not all ENT-doctors use this method in daily practice. Many of them use it empirically and obtain good results.

GOAL

To study the experience of ENT-doctors using the YAMIK nasal catheter (NC) in their clinical practice.

MATERIAL AND METHODS

To achieve the goal, a 16-question questionnaire was developed. Further, a survey of 30 ENT-doctors was conducted via e-mail.

RESULTS AND DISCUSSION

The study showed a marked dispersion of data regarding the time of starting therapy, the number of necessary procedures, as well as the components of medication solutions administered to the paranasal sinuses. At the same time, the effectiveness of the method, in doctors' opinion, is very high (above 90%). The incorrect technique of NC application, absence of studies according to the principles of Good Clinical Practice (GCP), and constructive disadvantages of NC may be probable reasons for the method undervaluation.

CONCLUSIONS

The prescription of procedures with NC to patients with ABRS is empirical and is probably related to the absence of clear indications for such treatment, data on its duration, and associated therapy. Consequently, research following GCP principles is required to develop an algorithm for treating ABSR with an NC. The development of a new design for an NC that will allow each ENT-doctor to learn the method is also appropriate.

Injectable and Self-Healing Hydrogel with Anti-Bacterial and Anti-Inflammatory Properties for Acute Bacterial Rhinosinusitis with Micro Invasive Treatment

Systemic antibiotic therapy is the main treatment for acute bacterial rhinosinusitis (ABRS). However, this treatment often causes side effects of dizziness, diarrhea, and drug resistance. In this study, a new polyethylene glycol hydrogel (PEG-H) treatment model is developed to achieve sustained release of drugs at the locality while avoiding those adverse effects. The PEG-H is composed of 4-arm-PEG-SH and silver ions through a high affinity and dynamic reversible coordination bond between the thiol and silver ion. In the initial test, PEG-H is loaded with Clarithromycin (CAM-Lips@Hydrogel) or Clarithromycin and Budesonide liposomes (CAM+BUD-Lips@Hydrogel). The results show that PEG-H maintains the characteristics of self-healing, biodegradability, moderate swelling rate, injectibility and sustained drug release. In in vivo studies, the hydrogel is injected into the maxillary sinus of ABRS rabbit models. In both a single or combined load, the hydrogel not only plays an effective role as an anti-bacterial, but also inhibits inflammatory response of local sinus mucosa. In addition, no other side effects are observed in the ABRS rabbit model through behavioral observation and drug sensitivity tests. Therefore, the injectable self-healing hydrogel with anti-bacterial and anti-inflammatory properties provides a new micro invasive therapeutic method for the clinical treatment of ABRS.

Can Diffusion-Weighted Imaging Serve as an Imaging Biomarker for Acute Bacterial Rhinosinusitis?

Acute rhinosinusitis is defined as symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses lasting less than four weeks. It is most commonly secondary to viral infection but is often challenging to distinguish from bacterial etiologies. Even with recommendations from several specialty societies, there continues to be a frequent practice of overprescribing oral antibiotics for acute rhinosinusitis, thus leading to multidrug-resistant organisms, and rendering oral medication useless when actually clinically warranted. We observed a potential non-invasive imaging biomarker that could predict which patients would benefit from anti-microbial therapy. Often computed tomography (CT) imaging is obtained by the provider before consultation with the otolaryngologist, sometimes leading to unnecessary radiation to the patient. In addition, there are no clear CT findings to make the diagnosis of acute rhinosinusitis. The diagnosis is challenging for all clinicians involved, and therefore, additional signs on other imaging modalities would be helpful. We present a series of four patients with incidentally discovered culture-positive acute rhinosinusitis. Patients with incidentally discovered culture-positive acute rhinosinusitis were found to also have magnetic resonance imaging (MRI) that showed corresponding restricted diffusion on diffusion-weighted imaging (DWI). An imaging biomarker for acute bacterial rhinosinusitis may improve the appropriate use of antibiotic therapy. DWI MRI should be further investigated as a potential candidate screening modality.

[The effectiveness of local therapy of acute inflammatory diseases of the upper respiratory tract]

Acute bacterial rhinosinusitis (ABRS) is one of the most common diseases in outpatient practice with a steady tendency to increase of complicated forms in recent years. The risk of antibiotic resistance makes it necessary to search for effective pathogenetic methods of ABRS treatment.

OBJECTIVE

To evaluate the efficacy of inhalation therapy with compressor nebulizer using Fluimucil Antibiotic IT in the treatment of ABRS and acute laryngotracheitis in outpatient practice.

MATERIAL AND METHODS

Patients with ABRS were divided into two sex- and age-matched groups of 26 people each. The first group was treated with 250 mg of Fluimucil Antibiotic IT inhalations by the use of Norditalia HI-NEB compressor nebulizer once a day. The second group was treated with amoxicillin/clavulanate 875 mg + 125 mg orally two times a day.

RESULTS

In the first group, the cough disappeared significantly earlier (on day 5-6) than in the second group (on day 7-8). In the first group, nasal congestion also disappeared significantly earlier (on day 3-5) than in the second group (on day 4-6). There was no significant difference in the reduction of intoxication syndrome and nasal secretions in both groups.

CONCLUSION

Local antibacterial and mucolytic therapy in the initial stages of ABRS and acute laryngotracheitis reduces rhinological symptoms and coughing, similar to systemic antibacterial therapy. The use of Fluimucil Antibiotic IT in the early stages of the treatment provides an opportunity to avoid systemic antibiotics, which reduces the risk of antibiotic resistance as well as side effects in patients.

[Characteristic of the microbiocenosis of the nasal mucous membrane in the patients presenting with acute bacterial rhinosinusitis]

The objective of the present work was to study the specific features of the microbiocenosis of the nasal mucous membrane in the patients presenting with acute bacterial rhinosinusitis (ABRS). We examined 86 patients with this condition at the age varying from 18 to 64 years. The control group consisted of practically healthy blood donors (n=156) registered at the Krasnoyarsk Regional Blood Centre #1; they were matched to the patients of the main study group in terms of the age and sex. In order to investigated bacterial flora of nasal mucosa from the standpoint of its role in the exacerbation of the disease, the microorganisms were cultured on the differential-diagnostic media. Their individual species were identified with the use of the conventional microbiological methods. They demonstrated the disturbances of the microbiocenosis of the nasal mucous membrane of the ABRS patients with the simultaneous increase of the total abundance of microorganisms regarded as potentially pathogenic ones. The study of pathogenic and persistent properties of the Staphylococcus strains isolated from the nasal mucosa of the patients suffering from acute bacterial rhinosinusitis, revealed the presence of practically all species supposed to be etiopathogenic agents able to produce the enzymes responsible for pathogenicity and persistence of the microorganisms. The results of the present study were interpreted as giving evidence of the disturbances of the microbiocenosis of the nasal mucosa resulting from the impairment of local immunity associated with trophic disorders in the mucous membrane of the nasal passages.