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Antibiotics for adults with acute laryngitis

Антибиотики для взрослых с острым ларингитом


Keywords:

Acute laryngitis – Острый ларингит

larynx – гортань

hoarseness – охриплость

fever – лихорадка

sorethroat – боль в горле

postnasaldischarge – выделение из носа

difficulty in swallowing – затруднения при глотании


   

This version published: 2013; Review content assessed as up-to-date: January 30, 2013.

Plain language summary

Acute laryngitis is an inflammation of the larynx. The most common symptoms are hoarseness, fever, sore throat, postnasal discharge and difficulty in swallowing. Antibiotics are frequently prescribed by physicians or self prescribed. Reasons for overprescribing antibiotics in upper respiratory tract infection such as acute laryngitis are varied but they often involve physicians' and patients' attitudes and expectations. This review found two studies involving 206 participants that evaluated the effectiveness of two different antibiotic therapies in adults with acute laryngitis. We found that penicillin V and erythromycin appear to have no benefit in treating acute laryngitis. Erythromycin could reduce voice disturbance at one week and cough at two weeks when measured subjectively. However, we consider these outcomes to be not relevant in clinical practice as the modest benefits from antibiotics may not outweigh their cost, adverse effects or negative consequences for antibiotic resistance patterns.

Abstract

Background: This is an updated version of the original review published in Issue 2, 2007 of The Cochrane Library. Acute laryngitis is a common illness worldwide. Diagnosis is often made by case history alone and treatment is often directed toward controlling symptoms.

Objectives: To assess the effectiveness and safety of different antibiotic therapies in adults with acute laryngitis. A secondary objective was to report the rates of adverse events associated with these treatments.

Search methods: We searched CENTRAL 2012, Issue 12, MEDLINE (January 1966 to January week 3, 2013), EMBASE (1974 to January 2013), LILACS (1982 to January 2013) and BIOSIS (1980 to January 2013).

Selection criteria: Randomised controlled trials (RCTs) comparing any antibiotic therapy with placebo for acute laryngitis. The main outcome was objective voice scores.

Data collection and analysis: Two review authors independently extracted and descriptively synthesised data.

Main results: Only two trials met the study inclusion criteria after extensive literature searches. One hundred participants were randomised to receive either penicillin V (800 mg twice a day for five days), or an identical placebo, in a study of acute laryngitis in adults. A tape recording of each patient reading a standardised text was obtained during the first visit, subsequently during reexamination after one and two weeks, and at followup after two to six months. No significant differences were found between the groups. The trial also measured symptoms reported by participants and found no significant differences.

The second trial investigated erythromycin for treating acute laryngitis in 106 adults. The mean objective voice scores measured at the first visit, at reexamination after one and two weeks, and at followup after two to six months did not significantly differ between control and intervention groups. At one week there were significant beneficial differences in the severity of reported vocal symptoms as judged by the participants (P = 0.042). Comparing the erythromycin and placebo groups on subjective voice scores, the a priori risk ratio (RR) was 0.7 (95% confidence interval (CI) 0.51 to 0.96, P = 0.034) and the number needed to treat for an additional beneficial outcome (NNTB) was 4.5.

Authors' conclusions: Antibiotics appear to have no benefit in treating acute laryngitis. Erythromycin could reduce voice disturbance at one week and cough at two weeks when measured subjectively. We consider that these outcomes are not relevant in clinical practice. The implications for practice are that prescribing antibiotics should not be done in the first instance as they will not objectively improve symptoms.

Editorial Group: Cochrane Acute Respiratory Infections Group.