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TerminatedNCT03369717Updated Jun 17, 2025Results posted

Use of Perioperative Antibiotics in Endoscopic Sinus Surgery

A Phase 4 interventional study of Amoxi Clavulanate in Chronic Sinus Infection, sponsored by Montefiore Medical Center. Terminated at 1 site in United States. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2025-06-17.

Sponsored by Montefiore Medical Center · Phase 4, Interventional, and Prevention

Why this study was terminated
Study terminated early
Phase
Phase 4
Study type
Interventional
Enrollment
24
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The objective of this study is to determine whether the use of postoperative antibiotics following endoscopic sinus surgery (ESS) decreases postoperative infection rates. This is a multi-institutional prospective study involving Albert Einstein College of Medicine/Montefiore Medical Center, Columbia University Medical Center, Weill Cornell Medical College, Mount Sinai Health System, and New York University Langone Medical Center. The study design will be a multi-institutional prospective randomized controlled trial with parallel random groups assigned to receive postoperative antibiotics or no postoperative antibiotics. The investigators hypothesize that patients who receive postoperative antibiotics will have lower postoperative infection rates and improved postoperative sinonasal symptoms and nasal endoscopy scores.

02

Conditions studied

  • Chronic Sinus Infection

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Keywords

  • endoscopic sinus surgery
  • antibiotics
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • Patients with Chronic Rhinosinusitis (CRS) with or without nasal polyposis or allergic fungal rhinosinusitis who present to the otolaryngology clinic who have been deemed suitable for bilateral ESS, and are over the age of 18 will be included.

Exclusion criteria

Exclusion Criteria:

  • Patients with sinonasal tumors, allergies or adverse reactions to all of the antibiotics that will be used in this study (amoxicillin-clavulanate, doxycycline, clarithromycin), immunodeficiency, cystic fibrosis, pregnancy, or diabetes with nasal polyposis (inability to receive systemic steroids) will be excluded, as will patients who lack capacity to provide informed consent. Patients undergoing active treatment for malignancy will be excluded. Patients undergoing unilateral ESS or with nonabsorbable packing placed at the time of surgery will be excluded. Patients who have been on antibiotics within 2 weeks of the surgery date will be excluded. Patients with acute on chronic sinusitis or the presence of purulence at time of surgery will be excluded from the study.
04

Study design

Phase
Phase 4
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
24 participants (actual)

Study arms

  • Experimental
    Antibiotics

    To receive postoperative antibiotics

    Drug: Amoxi Clavulanate

  • No intervention
    No antibiotics

    Will not receive any postoperative antibiotics

Interventions

  • DrugAmoxi Clavulanate

    Postoperative antibiotics

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What researchers measure

Primary outcomes

  1. Postoperative Infection

    The number/percentage of participants with postoperative infection rate, as assessed by rigid nasal endoscopy in the office and culture of suspected infectious material noted within the paranasal sinuses will be reported. A postoperative infection as defined by having an infection at ANY of the postoperative visits AND detected initially by evidence of purulence on nasal endoscopy will be considered an infection if the culture swab from the site of purulence during that office visit confirms that there is an actual bacterial source of the infection.

    Time frame: During all three scheduled postoperative visits: 7-10 days postoperatively; 2-4 weeks postoperatively; 6-8 weeks postoperatively

Secondary outcomes

  1. Postoperative Sino-nasal Outcome Test (SNOT-22) Scores

    Postoperative SNOT-22 scores will be summarized for each visit based on patient-reported symptoms. The SNOT-22 is a 22-item questionnaire used to assess the impact of chronic rhinosinusitis (CRS) on a patient's health-related quality of life. Participants are presented with a list of symptoms and social/emotional consequences of rhinosinusitis and asked to rate each problem over the prior 2-week period on a 6-point Likert scale ranging from 0 ("No Problem") to 5 ("Problem as bad as it can be)" yielding an overall possible scoring range of 0-110. Higher scores are indicative of a greater burden CRS-related symptoms. Scores are summarized by study arm using basic descriptive statistics.

    Time frame: During all three scheduled postoperative visits: 7-10 days postoperatively; 2-4 weeks postoperatively; 6-8 weeks postoperatively

  2. Perioperative Sinus Endoscopy (POSE) Scores

    Sinonasal crusting and inflammation was determined using the perioperative sinus endoscopy (POSE) scoring system based on patient-reported symptoms obtained during all three study visits. POSE assigns points to various areas within the nasal passages, based on the presence of certain conditions like crusting, edema, polyps, secretions, etc. For purposes of this study each parameter was scored from 0-2 yielding an overall possible score of 0-10, with higher scores being indicative of more extensive disease severity or surgical extent in the sinuses. Scores are summarized by study arm using basic descriptive statistics.

    Time frame: During all three scheduled postoperative visits: 7-10 days postoperatively; 2-4 weeks postoperatively; 6-8 weeks postoperatively

06

Results

Posted Jun 17, 2025
Limitations and caveats
We had a very low enrollment and therefore were unable to reach any statistical significance with any of our endpoints.

Participant flow

Participant flow — Overall Study
MilestoneAntibioticsNo Antibiotics
Started1212
Completed24
Not completed108

Outcome measures

PrimaryPostoperative Infection

The number/percentage of participants with postoperative infection rate, as assessed by rigid nasal endoscopy in the office and culture of suspected infectious material noted within the paranasal sinuses will be reported. A postoperative infection as defined by having an infection at ANY of the postoperative visits AND detected initially by evidence of purulence on nasal endoscopy will be considered an infection if the culture swab from the site of purulence during that office visit confirms that there is an actual bacterial source of the infection.

Time frame:
During all three scheduled postoperative visits: 7-10 days postoperatively; 2-4 weeks postoperatively; 6-8 weeks postoperatively
Reported as:
Count of participants · Participants
Postoperative Infection
ParticipantsAntibioticsNo Antibiotics
Postoperative Infection10
SecondaryPostoperative Sino-nasal Outcome Test (SNOT-22) Scores

Postoperative SNOT-22 scores will be summarized for each visit based on patient-reported symptoms. The SNOT-22 is a 22-item questionnaire used to assess the impact of chronic rhinosinusitis (CRS) on a patient's health-related quality of life. Participants are presented with a list of symptoms and social/emotional consequences of rhinosinusitis and asked to rate each problem over the prior 2-week period on a 6-point Likert scale ranging from 0 ("No Problem") to 5 ("Problem as bad as it can be)" yielding an overall possible scoring range of 0-110. Higher scores are indicative of a greater burden CRS-related symptoms. Scores are summarized by study arm using basic descriptive statistics.

Time frame:
During all three scheduled postoperative visits: 7-10 days postoperatively; 2-4 weeks postoperatively; 6-8 weeks postoperatively
Reported as:
Mean · score on a scale
Postoperative Sino-nasal Outcome Test (SNOT-22) Scores
score on a scaleAntibioticsNo Antibiotics
7 to 10 days post op25 ± 222 ± 1
2 to 4 weeks post op23 ± 1.521 ± 0.5
6 to 8 weeks post op22 ± 0.521 ± 0.5
SecondaryPerioperative Sinus Endoscopy (POSE) Scores

Sinonasal crusting and inflammation was determined using the perioperative sinus endoscopy (POSE) scoring system based on patient-reported symptoms obtained during all three study visits. POSE assigns points to various areas within the nasal passages, based on the presence of certain conditions like crusting, edema, polyps, secretions, etc. For purposes of this study each parameter was scored from 0-2 yielding an overall possible score of 0-10, with higher scores being indicative of more extensive disease severity or surgical extent in the sinuses. Scores are summarized by study arm using basic descriptive statistics.

Time frame:
During all three scheduled postoperative visits: 7-10 days postoperatively; 2-4 weeks postoperatively; 6-8 weeks postoperatively
Reported as:
Mean · score on a scale
Perioperative Sinus Endoscopy (POSE) Scores
score on a scaleAntibioticsNo Antibiotics
7 to 10 days post op5.4 ± 1.45.2 ± 1.1
2 to 4 weeks post op4.3 ± 0.64.1 ± 0.8
6 to 8 weeks post op3.8 ± 0.23.5 ± 0.4

Adverse events

Collected over Up to 8 weeks following endoscopic sinus surgery. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Antibiotics0/12 (0%)0/12 (0%)0/12 (0%)
No Antibiotics0/12 (0%)0/12 (0%)0/12 (0%)

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)AntibioticsNo AntibioticsTotal
<=18 years000
Between 18 and 65 years10818
>=65 years246
Age, Continuous
Age, Continuous(Years)AntibioticsNo AntibioticsTotal
Mean52 (25 to 71)46 (22 to 74)49 (22 to 71)
Sex: Female, Male
Sex: Female, Male(Participants)AntibioticsNo AntibioticsTotal
Female5813
Male7411
Region of Enrollment
Region of Enrollment(participants)AntibioticsNo AntibioticsTotal
United States121224
Race (NIH/OMB)
Race (NIH/OMB)(Participants)AntibioticsNo AntibioticsTotal
American Indian or Alaska Native000
Asian123
Native Hawaiian or Other Pacific Islander000
Black or African American459
White7411
More than one race000
Unknown or Not Reported011
Active Infection at time of surgery
Active Infection at time of surgery(Participants)AntibioticsNo AntibioticsTotal
Count of participants121224
07

Study locations

1 site
  • Montefiore Medical Center
    Bronx, New York 10467, United States
08

References and documents

Study documents

  • Protocol and statistical analysis plan · Jul 27, 2018

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

09

Registry details

Key details

Study ID
NCT03369717
Lead sponsor
Montefiore Medical Center
Collaborators
Mount Sinai Hospital, New York, NYU Langone Health, Weill Medical College of Cornell University, Columbia University
Responsible party
Sponsor
First posted
Dec 12, 2017
Start date
Aug 1, 2018
Primary completion
May 7, 2020
Completion
May 7, 2020
Results posted
Jun 17, 2025
Last update
Jun 17, 2025

Study contacts

Nadeem Akbar, MD
principal investigator · Assistant Professor

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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