Antibiotics for acute bronchitis.

Cochrane Database Syst Rev 2014 Mar 1(3):CD000245. Epub 2014 Mar 1.

Department of General Practice, Royal College of Surgeons, Beaux Lane House, Mercer St, Dublin, Ireland, 2.

Background: The benefits and risks of antibiotics for acute bronchitis remain unclear despite it being one of the most common illnesses seen in primary care.

Objectives: To assess the effects of antibiotics in improving outcomes and assess adverse effects of antibiotic therapy for patients with a clinical diagnosis of acute bronchitis.

Search Methods: We searched CENTRAL 2013, Issue 12, MEDLINE (1966 to January week 1, 2014), EMBASE (1974 to January 2014) and LILACS (1982 to January 2014).

Selection Criteria: Randomised controlled trials (RCTs) comparing any antibiotic therapy with placebo or no treatment in acute bronchitis or acute productive cough, in patients without underlying pulmonary disease.

Data Collection And Analysis: At least two review authors extracted data and assessed trial quality.

Main Results: Seventeen trials with 3936 participants were included in the primary analysis. The quality of trials was generally good. There was limited evidence to support the use of antibiotics in acute bronchitis. At follow-up, there was no difference in participants described as being clinically improved between antibiotic and placebo groups (11 studies with 3841 participants, risk ratio (RR) 1.07, 95% confidence interval (CI) 0.99 to 1.15; number needed to treat for an additional beneficial outcome (NNTB) 22. Participants given antibiotics were less likely to have a cough (four studies with 275 participants, RR 0.64, 95% CI 0.49 to 0.85; NNTB 6); have a night cough (four studies with 538 participants, RR 0.67, 95% CI 0.54 to 0.83; NNTB 7) and a shorter mean cough duration (seven studies with 2776 participants, mean difference (MD) -0.46 days, 95% CI -0.87 to -0.04). The differences in presence of a productive cough at follow-up and MD of productive cough did not reach statistical significance.Antibiotic-treated patients were more likely to be unimproved according to clinician's global assessment (six studies with 891 participants, RR 0.61, 95% CI 0.48 to 0.79; NNTB 25); have an abnormal lung exam (five studies with 613 participants, RR 0.54, 95% CI 0.41 to 0.70; NNTB 6); have a reduction in days feeling ill (five studies with 809 participants, MD -0.64 days, 95% CI -1.16 to -0.13) and a reduction in days with limited activity (six studies with 767 participants MD -0.49 days, 95% CI -0.94 to -0.04). The differences in proportions with activity limitations at follow-up did not reach statistical significance. There was a significant trend towards an increase in adverse effects in the antibiotic group (12 studies with 3496 participants) (RR 1.20, 95% CI 1.05 to 1.36; NNT for an additional adverse effect 5).

Authors' Conclusions: There is limited evidence to support the use of antibiotics in acute bronchitis. Antibiotics may have a modest beneficial effect in some patients such as frail, elderly people with multimorbidity who may not have been included in trials to date. However, the magnitude of this benefit needs to be considered in the broader context of potential side effects, medicalisation for a self-limiting condition, increased resistance to respiratory pathogens and cost of antibiotic treatment.

Download full-text PDF

Source
http://dx.doi.org/10.1002/14651858.CD000245.pub3DOI Listing
March 2014
4 Reads

Publication Analysis

Top Keywords

acute bronchitis
20
antibiotics acute
16
participants
12
productive cough
12
days 95%
12
studies
9
95%
9
reduction days
8
antibiotic therapy
8
effects antibiotic
8
reach statistical
8
limited evidence
8
-004 differences
8
support antibiotics
8
evidence support
8
adverse effects
8
cough studies
8
antibiotics
7
cough
6
acute
6

References

(Supplied by CrossRef)
Erythromycin in the treatment of acute bronchitis in a community practice
Brickfield et al.
Journal of Family Practice 1986
A placebo-controlled, double-blind trial of erythromycin in adults with acute bronchitis
Dunlay et al.
Journal of Family Practice 1987
The treatment of acute bronchitis with trimethoprim and sulfamethoxazole
Franks et al.
Journal of Family Practice 1984
Albuterol delivered by metered-dose inhaler to treat acute bronchitis
Hueston et al.
Journal of Family Practice 1994
Effectiveness of erythromycin in the treatment of acute bronchitis
King et al.
Journal of Family Practice 1996

Similar Publications