Telithromycin in Respiratory Tract Infections

Inclusion criteria

General Conditions

• Outpatients
• Fulfillment of clinical diagnostic criteria for one of the following indications:

• Mild to moderate Community Acquired Pneumonia (CAP)
• Acute bacterial Exacerbation of Chronic Bronchitis (AECB)
• Acute Sinusitis (AS)

For CAP

The Criteria to be fulfilled are:

• New onset of at least two of the following:

• Cough
• Production of purulent sputum
• Auscultatory findings compatible with pneumonia, e.g. rales, evidence of pulmonary consolidation
• Dyspnea or tachypnea
• Fever
• Elevated total white blood cell count > 10 000/mm3 or >15% bands regardless of total count
• Chest X-ray findings supporting a clinical diagnosis of bacterial pneumonia (e.g. new infiltrate)

For AECB

The Criteria to be fulfilled are:

• Chronic bronchitis defined as cough and excessive sputum production for more than 2 consecutive years and on most days in a 3-month consecutive period.
• Exacerbation defined by:

• Increase in sputum purulence, or
• Increase in sputum volume, or
• Increase in dyspnea

For AS

The criteria to be fulfilled are:

At least two of the major or one major and two minor factors listed below, for more than one week and less than 4 weeks:

• Major factors:

• Facial pressure and/or pain
• Facial congestion or fullness
• Nasal obstruction
• Nasal purulence or postnasal discharge
• Hyposmia or anosmia
• Fever
• Minor factors:

• Headache
• Halitosis
• Fatigue
• Dental pain
• Cough
• Ear pain, pressure or fullness

Exclusion criteria

General Conditions

Subjects presenting with any of the following will not be included in the study:

• Treatment required during the study with ergot alkaloid derivatives, pimozide, astemizole, terfenadine, cisapride, simvastatin, atorvastatin and lovastatin, and the oral use of the benzodiazepines midazolam, triazolam and alprazolam.
• History of congenital or family history of long QT syndrome (if not excluded by ECG) or known acquired QT interval prolongation.
• Known hypersensitivity to telithromycin or to macrolide antibiotics.
• Hospital acquired infections (hospitalization for more than 72 hours within 7 days of study entry).
• Pregnant or breast-feeding women. For the women of childbearing potential it is left to the investigators discretion to establish a lack of pregnancy, e.g. with contraceptive use, menstrual pattern, urinary pregnancy test.
• Subjects with severely impaired renal function (creatinine clearance <30 ml/min).
• Subjects that had received anti-bacterials for more than 24 hours within 7 days prior to enrollment in the study, unless the treatment has failed.
• Subjects receiving medications, including other anti-microbials or anti-cancer drugs, that could interfere with the evaluation.
• Microbiologically documented infection with a pathogen known prior to inclusion to be resistant to the study medications.
• Infection, other than the primary infection for which the subject is being included in the study that requires use of other systemic anti-bacterial drug.
• Splenectomised subjects.
• Use of Ketek® (telithromycin) or participation in a study using Ketek® (telithromycin) in the previous 30 calendar days.
• Subjects that have received any investigational drug within 4 weeks of enrollment in the study.
• No subject will be allowed to enroll in this study more than once.

For CAP

Additional exclusion criteria are:

• Severe pneumonia defined by any one of the following:

• Judged as needing Intensive Care Unit admission.
• Need of parenteral antibiotic treatment (if the attending physician wants to prescribe a parenteral treatment for adherence reasons or local prescription habits this is accepted, provided that the patient does not have a severe pneumonia).
• Acute respiratory failure or requirement for mechanical ventilation.
• Altered mental status resulting from the infective process.
• Resting respiratory rate > 30 breaths/min.
• Chest X-ray showing increase in opacity by > 50% within 48 hours of current evaluation.
• Total white blood cell count < 4 000/mm3.
• Aspiration pneumonia.
• Pneumonia suspected to be non-bacterial (due to fungus or viral).
• Subjects suffering from severe bronchiectasis (production of more than 125 mL of sputum/day), cystic fibrosis, active tuberculosis, pulmonary infarction or embolism, bronchial obstruction, lung cancer or lung metastasis, lung abscess, extra-pulmonary extension (like meningitis, septic arthritis, endocarditis).

For AECB

Additional exclusion criteria are:

• Need of parenteral antibiotic treatment (if the attending physician wants to prescribe a parenteral treatment for adherence reasons or local prescription habits this is accepted, provided that the patient does not have a severe infection).
• Acute respiratory failure (respiratory distress, hypercarbia, worsening hypoxemia) or requirement for mechanical ventilation.
• Severe bronchiectasis, cystic fibrosis, active tuberculosis, pulmonary infarction or embolism, bronchial obstruction, lung cancer or lung metastasis, lung abscess.

For AS

Additional exclusion criteria are:

• Need of immediate surgery for the treatment of AS.
• Chronic sinusitis (symptoms lasting more than 4 weeks).
• Recurrent sinusitis (4 or more episodes of sinusitis requiring antibiotic therapy in the previous 12 months).
• Nosocomial acquired sinusitis.
• Cystic fibrosis, immotile cilia syndrome.
• Obstructive lesions in nasopharynx (e.g. polyps, tumor).
• Use of nasal, nasogastric or nasotracheal catheters.