Comparative effectiveness of levofloxacin versus third-generation cephalosporins and predictors of treatment outcomes in upper respiratory tract scleroma: a tertiary center experience

Upper respiratory tract scleroma is a chronic granulomatous disease that primarily affects the nose but may involve any part of the upper respiratory tract. The mainstay of treatment is prolonged antibiotic therapy. This prospective comparative study included 90 adults with upper respiratory tract scleroma treated at Minia University Hospital, Egypt, between September 2024 and August 2025. Patients were randomly allocated into two equal groups using closed sealed opaque envelopes to receive levofloxacin or third-generation cephalosporins for three months. The mean age was 36.3 ± 10.4 years, and 90% were females. Nasal obstruction (96.7%) and nasal crustation (90%) were the most common manifestations. Rhinolaryngoscleroma was diagnosed in 86.7% of patients, whereas 13.3% had rhinoscleroma. Clinical improvement was significantly higher with levofloxacin than with third-generation cephalosporins (80% vs. 60%, P = 0.038). In the multivariable analysis, treatment type and pharyngeal involvement remained significant predictors of clinical improvement. Levofloxacin treatment was associated with higher odds of improvement (OR = 5.8, P = 0.015). These findings highlight the importance of early diagnosis and appropriate antibiotic selection in the management of upper respiratory tract scleroma.