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.