Nasal Steroids, Irrigation, Oral Antibiotics, and Subgroup Targeting for Effective Management of Sinusitis

NCT ID: NCT06076304

Last Updated: 2025-07-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

3720 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-11-21

Study Completion Date

2028-12-31

Brief Summary

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Sinus infections are sometimes treated with oral antibiotics or nasal steroid sprays, while some patients get better on their own. Some patients may wait a few days or use common over-the-counter remedies to see if their symptoms improve without further treatment. Sometimes this is enough to help patients wait a few days to see if their infection clears up without needing to use antibiotics or nasal steroid sprays. The overall goal of this clinical trial to see which specific groups of patients benefit more from which intervention or combination of intervention, and which improve with supportive care alone.

Detailed Description

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One in seven adults are diagnosed with acute sinus infections (also known as rhinosinusitis or ARS) every year in the United States, for an annual total of 30 million office visits. Most acute sinus infections seen in outpatient setting are caused by viral infection, but antibiotics are prescribed in over 70% of these visits. The overarching goal is to improve outcomes for patients with ARS by understanding which subgroups are most likely to benefit from antibiotics, supportive care, watchful waiting, intranasal corticosteroids (INCS), or a combination of treatments.

To assess the comparative effectiveness of the treatments, a large, pragmatic, randomized controlled trial, will be conducted in primary and urgent care clinics within six geographical areas. Enrolled adults ages 18-75 years presenting to a clinician with symptoms consistent with ARS will enter the study in one of 2 phases, dependent on the number of days with symptoms. Phase 1 is a pre-randomization, waiting period of 9 or more days, with options for supportive care. Patients who qualify will enter Phase 2 and will be randomly assigned to one of the four arms. All groups will use approved or over-the counter drugs or spray, or a placebo (inactive or dummy pill). Patients will be in Phase 2 for approximately 14 days. All patients will complete a two-minute daily diary and periodic follow-ups about their symptoms.

Conditions

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Sinus Infection Acute Sinusitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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antibiotic

amoxicillin/clavulanate

Group Type ACTIVE_COMPARATOR

Amoxicillin/Clavulanate Potassium 875 MG-125 MG Oral Tablet

Intervention Type DRUG

Amoxicillin/clavulanate, oral, 875mg/125mg twice daily for 7 days

C-reactive protein

Intervention Type OTHER

Measurement of C-reactive protein level in capillary blood

placebo antibiotic

placebo antibiotic, amoxicillin/clavulanate

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Placebo for amoxicillin/clavulanate, oral, twice daily for 7 days

C-reactive protein

Intervention Type OTHER

Measurement of C-reactive protein level in capillary blood

antibiotic plus intranasal corticosteroid

amoxicillin/clavulanate plus budesonide

Group Type ACTIVE_COMPARATOR

Amoxicillin/Clavulanate Potassium 875 MG-125 MG Oral Tablet

Intervention Type DRUG

Amoxicillin/clavulanate, oral, 875mg/125mg twice daily for 7 days

Budesonide nasal spray

Intervention Type DRUG

Budesonide nasal spray, 32 mcg per spray, 2 sprays per nostril, once per day

C-reactive protein

Intervention Type OTHER

Measurement of C-reactive protein level in capillary blood

placebo antibiotic plus intranasal corticosteroid

placebo antibiotic plus budesonide

Group Type OTHER

Placebo

Intervention Type DRUG

Placebo for amoxicillin/clavulanate, oral, twice daily for 7 days

Budesonide nasal spray

Intervention Type DRUG

Budesonide nasal spray, 32 mcg per spray, 2 sprays per nostril, once per day

C-reactive protein

Intervention Type OTHER

Measurement of C-reactive protein level in capillary blood

Interventions

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Amoxicillin/Clavulanate Potassium 875 MG-125 MG Oral Tablet

Amoxicillin/clavulanate, oral, 875mg/125mg twice daily for 7 days

Intervention Type DRUG

Placebo

Placebo for amoxicillin/clavulanate, oral, twice daily for 7 days

Intervention Type DRUG

Budesonide nasal spray

Budesonide nasal spray, 32 mcg per spray, 2 sprays per nostril, once per day

Intervention Type DRUG

C-reactive protein

Measurement of C-reactive protein level in capillary blood

Intervention Type OTHER

Other Intervention Names

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Augmentin Inactive Control Rhinocort CRP

Eligibility Criteria

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Inclusion Criteria

1. 18-75 years old; AND are experiencing either:
2. "persistent" symptoms or signs compatible with ARS or sinus infection lasting for 1-21 days without any evidence of clinical improvement (Symptoms include facial pain or pressure, facial congestion or fullness, nasal obstruction, nasal discharge, no or reduced sense of smell, fever ≤39°C or 102°F, headache, bad smelling breath, fatigue, ear pain or pressure, and dental pain); OR
3. onset with worsening symptoms or signs characterized by the new onset of fever, headache, or increase in nasal discharge following a typical viral upper respiratory infection (URI) that lasted 5-6 days and were initially improving (''double-sickening'').

Exclusion Criteria

* allergy or intolerance to penicillin
* received systemic antibiotic therapy in the past 4 weeks
* prior sinus surgery (cosmetic surgery, such as rhinoplasty, septal deviation, etc. are not exclusionary)
* complications of sinusitis (facial edema (swelling), cellulitis), or orbital, meningeal or cerebral signs)
* health care clinician determined IV (intravenous) antibiotics or hospital admission are required
* pregnancy or breastfeeding
* presence of a comorbidity or medication that may impair a patient's immune response as determined by a health care clinician
* hospitalization in past 5 days
* unable or unwilling to provide informed consent or comply with study protocol requirements
* fever \>39°C or 102°F today
* taking intranasal corticosteroids (INCS) regularly in the past two weeks and unwilling to stop its use while in the study; OR
* previously enrolled or participated in the feasibility phase or this stage of study
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Patient-Centered Outcomes Research Institute

OTHER

Sponsor Role collaborator

Medstar Health Research Institute

OTHER

Sponsor Role collaborator

Penn State College of Medicine

UNKNOWN

Sponsor Role collaborator

University of Washington

OTHER

Sponsor Role collaborator

Virginia Commonwealth University

OTHER

Sponsor Role collaborator

University of California, Los Angeles

OTHER

Sponsor Role collaborator

University of Wisconsin, Madison

OTHER

Sponsor Role collaborator

Daniel Merenstein

OTHER

Sponsor Role lead

Responsible Party

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Daniel Merenstein

Director of Research Programs, Department of Family Medicine, Principal Investigator, Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Dan Merenstein, MD

Role: PRINCIPAL_INVESTIGATOR

Georgetown University

Locations

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University of California, Los Angeles

Los Angeles, California, United States

Site Status RECRUITING

Georgetown University Medical Center

Washington D.C., District of Columbia, United States

Site Status RECRUITING

MedStar Health Research Institute

Hyattsville, Maryland, United States

Site Status NOT_YET_RECRUITING

Penn State College of Medicine

Hershey, Pennsylvania, United States

Site Status RECRUITING

Virginia Commonwealth University

Richmond, Virginia, United States

Site Status RECRUITING

University of Washington

Seattle, Washington, United States

Site Status RECRUITING

University of Wisconsin-Madison

Madison, Wisconsin, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Lead Project Coordinator

Role: CONTACT

202-687-6454

Other Identifiers

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23-02-622

Identifier Type: OTHER

Identifier Source: secondary_id

PLACER-2021C3-24476

Identifier Type: -

Identifier Source: org_study_id

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