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Antibiotics and Acute Cough: A Useless Mixture.

Acute cough and respiratory tract infections are usually caused by viruses, but they are nevertheless often treated with antibiotics (see JW Oct 15, 1997, p. 157, or JAMA 1997; 278:901). Although there have been a number of studies designed to address the efficacy of antibiotics in acute cough, the risk for illness with and without antibiotics has not been carefully quantified. British investigators performed a meta-analysis of nine randomized trials (eight published) involving 515 people with acute cough; in general, these studies enrolled patients labeled as having "acute bronchitis," and excluded patients with COPD or clinical evidence of pneumonia.

At 7 to 11 days, the proportion of patients with productive cough was no different for those receiving antibiotic or placebo. The same was true for the proportion of people deemed clinically improved, but there was a nonsignificant trend favoring antibiotics. The proportion of people reporting side effects was higher in people taking antibiotics, but the difference was not significant. When the one trial reporting an increase in side effects among placebo recipients was excluded, the heterogeneity of subjects was reduced, and the risk for side effects with antibiotics was significantly higher (relative risk, 1.9).

Comment: In adults with acute cough and no chronic lung disease or evidence of pneumonia, the benefits of antibiotics appear to be marginal, and are likely to be offset by a higher risk for side effects.

— KI Marton

Published in Journal Watch General Medicine April 21, 1998

Citation(s):

Fahey T et al. Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults. BMJ 1998 Mar 21 316 906-910.

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