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Antibiotics for the common cold and acute purulent rhinitis

  1. Tim Kenealy*,
  2. Bruce Arroll

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 4 JUN 2013

Assessed as up-to-date: 26 FEB 2013

DOI: 10.1002/14651858.CD000247.pub3


How to Cite

Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD000247. DOI: 10.1002/14651858.CD000247.pub3.

Author Information

  1. University of Auckland, Department of General Practice and Primary Health Care, Auckland, New Zealand

*Tim Kenealy, Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand. t.kenealy@cochraneprimarycare.org.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 4 JUN 2013

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Characteristics of included studies [ordered by study ID]
De Sutter 2002

MethodsRandomised controlled trial, double-blind


Participants12 years old or older with respiratory tract infection and purulent rhinorrhoea


InterventionsAmoxicillin 500 mg 3 times daily for 10 days


OutcomesDuration of general illness (NS); duration of pain (NS) and duration of purulent rhinorrhoea (P = 0.007). Persisting purulent rhinitis in amoxicillin group 116/189 and in the placebo group 136/195


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputer-generated random number list

Allocation concealment (selection bias)Low riskAdequate: sequentially numbered

Blinding (performance bias and detection bias)
All outcomes
Low riskBlinding maintained due to identical capsules and confirmed by asking physicians and participants to guess what group they were in

Incomplete outcome data (attrition bias)
All outcomes
Low riskAlmost identical follow-up in both arms; 42/416 (10%) drop-out

Selective reporting (reporting bias)Low riskAll expected outcomes reported

Other biasHigh riskPossibility that > 60% of participants may have had sinusitis (see Table 1 in De Sutter 2002 paper)

Gordon 1974

MethodsRandomised controlled trial, double-blind


ParticipantsChildren at a casualty department, symptoms referable to respiratory tract, rhinitis most common 78% to 95%, most had cough and wheeze, no antibiotics in previous week, no pneumonitis
63% of children had wheeze in the under 2-year age group while 22% had wheeze in the 2 years to 4 years age group. In children under 2 years 13% had clinical signs in the chest and 13% in those over the age of 6 years. 88 had streptococcal throat swabs, only 2 of which were positive. Number of drop-outs = 89


InterventionsAmpicillin, penicillin, erythromycin palmitate each 125 mg 4 x daily and in over 2-year olds given double dose; duration not stated. Medication given in numbered bottles and the code was not broken until the end of the trial


Outcomes89 children started
Outcomes at 5 days: placebo better than ampicillin (P = 0.05) for relief of symptoms while antibiotics no better for symptoms or signs


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskRandomised, method not described

Allocation concealment (selection bias)Unclear riskProcess not described

Blinding (performance bias and detection bias)
All outcomes
Low riskIdentical numbered bottles

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskAny child who took less than half the medication was excluded; no number is given and it appears that the report concerns only those 89 remaining (0% drop-out)

Selective reporting (reporting bias)Low riskYes

Other biasUnclear risk"Most of the children had cough or wheeze suggesting that the intrathoracic passages were involved"

Herne 1980

MethodsRandomised controlled trial, double-blind


Participants75 military men aged 16 to 23 years with acute seasonal upper respiratory tract infections with no obvious severe signs. 7 were removed from the analysis because they clinically appeared to have streptococcal tonsillitis, therefore n1 = 75, n2 = 68 (i.e. 7 removed). No drop-outs


InterventionsXibornol 250 mg 2 tablets 3 times daily or tetracycline 250 mg 2 tablets 3 times per day or matching placebo


OutcomesPersisting symptoms (Table 7 in Herne 1980) xibornol 3/22, tetracycline 4/24 and placebo 10/22 therefore all antibiotics 7/46. Antibiotics were significantly better than placebo for fever at day 5 and for residual clinical signs and symptoms. Rhinitis 3/46 for antibiotic and 5/22 for placebo (not stated if it was purulent or clear); sore throat 2/46 for antibiotic and 8/22 for placebo. No adverse effects were reported


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskRefer to randomisation and double-blinded but no details

Allocation concealment (selection bias)Unclear riskProcess not described

Blinding (performance bias and detection bias)
All outcomes
Low riskIdentical capsules

Incomplete outcome data (attrition bias)
All outcomes
Low riskComplete follow-up apart from 7 drop-outs with streptococcal tonsillitis in approximately equal numbers. 7/75 drop-out (9%)

Selective reporting (reporting bias)Low riskYes

Other biasHigh riskPossibility that more participants may have had bacterial rather than viral infections, for example pharyngitis/rhinopharyngitis 21 participants and tonsillitis 10 participants (in Table 1 of Herne 1980)

Hoaglund 1950

MethodsDispensed in rotation by pharmacist


ParticipantsHealthy young males with local and constitutional symptoms and thick nasal discharge, military recruits. No drop-outs, n = 309


InterventionsPlacebo, aureomycin 1 g/day for first 69 participants, then aureomycin 2 g/day in the remaining 85


OutcomesNo benefit in 24 hours: 39/154 (antibiotic), 51/155 (placebo)


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskMedication dispensed by pharmacist "in rotation"

Allocation concealment (selection bias)Unclear riskNo process is described

Blinding (performance bias and detection bias)
All outcomes
Unclear riskGiven aureomycin or inert yellow capsules but it is not stated that the placebo was identical

Incomplete outcome data (attrition bias)
All outcomes
Low riskWe assume 100% follow-up in this military study

Selective reporting (reporting bias)Low riskYes

Other biasHigh risk24-hour outcome assessment possibly too short for any antibacterial effect

Howie 1970

MethodsRandomised controlled trial, double-blind; medicine sent to participants in advance of illness


ParticipantsGiven at home to male participants, 20 to 49 years, from Glasgow General Practices; start medicine if cold or influenza-like illness not getting better after 2 days. No physical exam hence no lower respiratory tract signs reported. Of 829 potential participants, 293 took antibiotics and 250 took placebo. 66 were excluded because of chronic respiratory signs or symptoms and 198 took no medication. 22 returned no cards


InterventionsDemethylchlortetracycline 300 mg twice daily for 5 days and matching placebo; given 2 days after onset


OutcomesPurulent sputum/spit/purulent nasal discharge and cough - all NS - the denominator is the number of illnesses not individuals. Adverse effects 2.9% (placebo) and 9.5% (antibiotic) or 25/293 (antibiotic) and 7/250 (placebo) (NS). 5 participants had adverse effects more than once therefore change 25 to 20 and 293 to 288 (participants as denominator)

Work loss: 98/448 on antibiotic treatment and 96/388 on placebo
Work loss 1.1 average days versus 1.5 per illness on placebo. Work loss 22% (antibiotic) and 25% (placebo); more than 10 days 2.9% (antibiotic) versus 5.3% (placebo)


NotesDenominator is illnesses, except for adverse effects and work loss which are numbers of participants


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskStated to be randomised

Allocation concealment (selection bias)Low riskAdequate code number

Blinding (performance bias and detection bias)
All outcomes
Low riskPlacebo stated to be matching and the difference was not detectable to the medically qualified participants

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskBoth groups got similar numbers of treatments; 28/857 people did not return their symptom cards; the report is therefore on the remaining 829; 66 participants who may have had chronic bronchitis were excluded from the main analysis as were 40 illnesses (not participants) where people attended their doctor rather than take the trial medication. 28/829 (3.3%) dropped out and 106 were excluded

Selective reporting (reporting bias)Low riskYes

Other biasLow riskYes

Kaiser 1996

MethodsRandomised controlled trial, double-blind


ParticipantsAdult participants aged over 16 with a history of acute upper respiratory infection with nasal congestion or rhinorrhoea or pharyngitis who presented with a common cold to the hospital outpatient department. Exclusion = facial pain, sinusitis, purulent pharyngitis, purulent or chronic bronchitis, bronchopneumonia, use of antibiotics in previous 10 days, allergy to aminopenicillins. Each patient had a nasopharyngeal aspiration for bacteriological culture (n = 288; excluding 26 drop-outs)


Interventions5 days of co-amoxiclav 375 mg tid for 5 days or a placebo


OutcomesTable 2 (in Kaiser 1996) at day 5. Persistent or worse 97/146 (antibiotic) and 94/142 (placebo)

Adverse effects 34/146 (antibiotic) and 7/142 (placebo); GI disturbances or diarrhoea

Significant finding for cure with antibiotics in the group that were culture positive for S. pneumoniae, M. catarrhalis or H. influenzae (58 participants; 27% versus 4%; P value 0.001)


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskStated randomly assigned but did not state how it was done

Allocation concealment (selection bias)Unclear riskProcess not stated

Blinding (performance bias and detection bias)
All outcomes
Low riskBottles were numbered otherwise same for intervention and control

Incomplete outcome data (attrition bias)
All outcomes
Unclear risk6.2% drop-out rate

Selective reporting (reporting bias)Low riskYes

Other biasUnclear risk19% of participants had sinusitis on X-ray which may have influenced the group with positive nasopharyngeal swabs

Lexomboon 1971

Methods? random selection of coloured strips from a box; only pharmacists knew of allocation


ParticipantsHospital outpatients children 6 months to 12 years with upper respiratory symptoms and fever
64% had bacterial pathogens in nasopharyngeal samples. Drop-outs not mentioned, n = 261


InterventionsPenicillin V for 7 days 30 mg/kg, tetracycline 40 mg/kg for 7 days and placebo syrup


OutcomesFailure of treatment in penicillin 3/86, 5/88 tetracycline and 4/87 in placebo


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskTherapeutic regimen determined by selection of coloured chips from a box

Allocation concealment (selection bias)Unclear riskProcess depended on blinding of selecting physician remaining intact throughout the study

Blinding (performance bias and detection bias)
All outcomes
Low riskOnly the pharmacy knew the contents of the syrups implying the clinicians and the participants did not know

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskWhole report includes only those in whom there was no definitive clinical diagnosis (this is appropriate) and those who attended at least 3 of the 4 follow-up visits - the number failing to attend for follow-up is not mentioned

Selective reporting (reporting bias)Low riskYes, apart from those not returning for follow-up

Other biasLow riskYes

McKerrow 1961

MethodsRandomised controlled trial


ParticipantsNormal participants from research unit. The pneumoconiosis group in the factory is not included. No drop-outs. Aged 15 to 69 years, n = 33. This study included 2 groups. An office group otherwise healthy and a factory group some of whom had pneumoconiosis. The factory subgroup was excluded


InterventionsTetracycline 15 mg 3 daily for 3 days or oxytetracycline 15 mg or chlortetracycline 15 mg 3 daily. The antibiotic was chosen according to the sensitivity reactions of the participants' saliva. In factory 22 took placebo and 28 took active medication; in the unit 15 took medication and 18 took placebo


OutcomesFirst cold. Table 3 (in McKerrow 1961) unit office data. No cure or improvement in 3 days. 5/15 (A - all tetracycline), 8/18 (placebo). Adverse events for both groups 9/43 antibiotic 0/40 placebo. Adverse effects in unit group assigned to tetracycline = 3/15 and 0/18 placebo


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskThere was mention of allocation at random (2-step: first random to active versus control; then random allocation for active group to an antibiotic to which their flora were sensitive)

Allocation concealment (selection bias)Low riskAn elaborate process described to mask the fact that there was no identical dummy tablet for the chlortetracycline

Blinding (performance bias and detection bias)
All outcomes
Low riskAlthough there was no identical dummy tablet for the chlortetracycline, the authors were satisfied that their elaborate process kept the medication identity hidden; they went to particular lengths to ensure this

Incomplete outcome data (attrition bias)
All outcomes
Low riskComplete follow-up

Selective reporting (reporting bias)Low riskNone detected

Other biasHigh riskThe trial was for 3 days and they used very low doses of tetracycline, e.g. 15 mg (today the doses would be at least 10 times those doses)

Taylor 1977

MethodsRandomised controlled trial with 3 groups; double-blind


ParticipantsNasopharyngitis, pharyngo-tonsillitis and bronchitis
Children aged 2 to 10 years in general practice. 43% had auscultatory evidence of more extensive airways disease (n = 188 excluding 9 drop-outs)


InterventionsPlacebo, co-trimoxazole 40 mg/5 ml, amoxicillin 125/5 ml for 5 days


OutcomesNumbers with activity not returned day 7
Co-trimoxazole = 6/75, amoxicillin = 6/54, placebo = 3/59

Appetite not returned day 7
Co-trimoxazole = 11/75, amoxicillin = 11/54, placebo = 11/59

Symptoms at day 8
Runny nose clear = amoxicillin 8/54, co-trimoxazole = 21/75, placebo = 22/59

Runny nose purulent at day 8
Amoxicillin = 3/54, co-trimoxazole = 3/75, placebo = 9/59

Sore throat at day 8
Amoxicillin = 3/54, co-trimoxazole = 3/75, placebo = 3/59

Adverse effects at day 8 (rash, vomiting and diarrhoea)
Co-trimoxazole = 18/75, amoxicillin = 8/54, placebo = 11/59


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskThe term "randomly assigned" was used

Allocation concealment (selection bias)Unclear riskProcess not described

Blinding (performance bias and detection bias)
All outcomes
Low riskNot clear if medications were masked but word "double-blind" used

Incomplete outcome data (attrition bias)
All outcomes
Low risk5% did not complete (as they were placed on open antibiotic in the meantime) but unlikely to affect the results

Selective reporting (reporting bias)Low riskNo selective reporting noted

Other biasHigh risk43% of participants had lower respiratory signs so may not all have had common colds

Todd 1984

MethodsRandomised controlled trial, placebo-controlled, 4 groups


ParticipantsChildren older than 2 months of age in an army medical centre with non-transparent anterior nasal discharge. Normal tympanic membranes, no evidence of foreign body, no history of allergic rhinitis and no adverse reactions to the study drugs. 142 started, 107 analysed, 35 drop-outs


InterventionsCephalexin oral 25 to 50 mg/kg/day max 2 g and pseudoephedrine/triprolidine 1 to 4 teaspoons per day and matching placebos. Medication code broken if group A streptococcus found on nasopharyngeal cultures and excluded if developed a treatable illness, for example otitis media


OutcomesDay 5 to 6 nasal purulent discharge
22/29 cephalexin + pseudoephedrine/triprolidine, 20/26 cephalexin + placebo, 17/27 pseudoephedrine/triprolidine + placebo, 15/24 placebo + placebo

Drug adverse effect (rash, hyperactivity, diarrhoea, vomiting) 2/23, placebo 4/17


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskSequentially into pre-randomised groups (we do not understand what this means)

Allocation concealment (selection bias)Unclear riskProcess not described

Blinding (performance bias and detection bias)
All outcomes
Low risk"Identical appearing placebos", neither parents not health professionals were aware of the contents of the medications

Incomplete outcome data (attrition bias)
All outcomes
Unclear risk35 drop-outs due to developing another treatable illness; failure to return for follow-up; non-confirmed compliance, leaving 107. A further 9 grew Group A streptococci and were put on antibiotics but the outcomes table (Table 6) appears to include 107 participants at the highest count and there is a lot of missing data. 35/142 dropped out (25%)

Selective reporting (reporting bias)Low riskNo selection beyond the missing data

Other biasLow riskNone noted

Vogt 1966

MethodsRandomised controlled trial with 2 groups


ParticipantsPaediatric population, median age in each group between 1 and 2 years


InterventionsNasal phenylephrine with nitrofurazone 0.02% (intervention) and phenylephrine (control)


OutcomesClearance of purulent rhinitis at 4 days


Notes43 of the 50 intervention group and 41 of the control group were given an oral antibiotic


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskMay not have been formally randomised; participants were "haphazardly assigned" to groups

Allocation concealment (selection bias)Unclear riskProcess not described

Blinding (performance bias and detection bias)
All outcomes
Low riskThe medication was probably put into identical bottles that were marked only with a code number. Neither patient nor physicians knew the allocation

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo loss to follow-up, information was collected from every patient

Selective reporting (reporting bias)Low riskYes

Other biasLow riskNo other biases noted

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Ackerman 1968Excluded as had active control, i.e. Robitussin, a cough suppressant. Used penicillin V 100,000 units 4 times daily for 10 days, tetracycline 50 mg 4 times daily for 10 days, compared with Robitussin. Results: no difference in shortening the median duration of illness or in preventing secondary complications

Banks 1965Excluded as used ascorbic acid as control group. Results: no difference between tetracycline, spiramycin and ascorbic acid

Banks 1969This paper is a reappraisal of 2 studies reported in Medical Officer 1968;119:7-8. Excluded as control groups had ascorbic acid and kaolin
This was a preventive trial of the common cold in 1962 to 1963 and another trial in 1965 to 1967 for preventive treatment of the common cold. Excluded as ascorbic acid plus spiramycin was compared with spiramycin

Bateson 1961Not randomised and controlled

Bessel-Lorck 1959Excluded as antibiotics used for prophylaxis

Burke 1956Excluded as antibiotics given prophylactically. Results: in children awaiting tonsillectomy antibiotics were associated with 25 colds compared with 60 on calcium tablets (P < 0.01). The antibiotic group had 30 weeks school absence while the group on calcium tablets had 80 weeks school absence (P < 0.001)

Cronk 1954Excluded as control group had salicylamide in their medication. Results: better response to salicylamide than to penicillin

Darelid 1993Excluded as study subjects had cough for 10 days minimum; M. catarrhalis in 75% of children. An open study with control group untreated. Results: 88% better in erythromycin group versus 36% in untreated group (P < 0.0001)

Fraser 1962Excluded as used aspirin in control participants. Results: phenoxymethylpenicillin and oxytetracycline were no better than aspirin

Gottfarb 1994Excluded as study subjects had cough for 10 days minimum. Results: 71% improved on antibiotic while 22% improved on placebo

Gupta 1997Excluded as had no placebo control group

Haight 1954Excluded as 28.7% had group A beta haemolytic streptococcus. Results: in non-bacterial group there was no difference between erythromycin and penicillin and placebo

Hardy 1956Excluded as not randomised into treatment groups, i.e. supposedly rotated medication but left with unequal numbers in each of 4 groups. The authors of the paper expressed their concern over the adequacy of randomisation. Also excluded as at least 14% had Group A beta haemolytic streptococci. Results: no benefit from antibiotics

Haye 1998All participants had symptoms for more than 10 days

Jones 1953Excluded as used acetylsalicylic acid in control participants. Results: no benefit from antibiotics

Knox 1962Excluded as used acetylsalicylic acid in control participants. Results: no difference between antibiotics and aspirin

Kuh 1949Excluded as antibiotics given prophylactically

Lapin 1984Excluded as antibiotics given prophylactically. Penicillin group experienced a lower rate of upper respiratory tract infections and a reduction in the number of febrile days compared with the no prophylaxis group

Lockhart 1961Excluded as not randomised or controlled. Results: not able to assess any benefit

Marlow 1989Excluded as did not meet the entry criteria for URTI, i.e. no rhinitis. Results: statistically significant improvement in sickness but not in soreness of throat

McLane 1952Excluded as control group received APC (acetylsalicylic acid, phenacetin and caffeine) and/or antihistamine. Results: APC and antihistamine and procaine penicillin were more effective at relieving nasopharyngeal symptoms and preventing secondary complications than APC alone or with antihistamine

Reinert 1991Excluded because antibiotic combined with topical cortisone. Results: the tixocortol neomycin combination was more effective at controlling symptoms at 7 days than the placebo

Ritchie 1958Corrupted randomisation. Results: the proportion of participants who had full colds was consistently lower in the antibiotic group than in the control group

Seal 1953Excluded as antibiotics given prophylactically and focus on streptococcal tonsillitis. Results: both penicillin and chlortetracycline were effective in the prevention of streptococcal infections during the period of administration

Sulman 1958Excluded as not randomised. Results: showed a benefit for chloramphenicol

Sutrisna 1991Excluded as there was no placebo control group. Results: antibiotic no better than control group

Townsend 1960Excluded as used prophylactic antibiotics. Results: no benefit from antibiotics

Townsend 1962Excluded as control group not obtained by randomisation. Results: no benefits from antibiotics

Traisman 1955Excluded as not randomised - simply divided in to 4 groups. Results: no benefit from antibiotics

Wald 1991Patients were children less than 2 years age who had persistent nasal discharge for at least 10 days that had not begun to improve before trial entry. RCT with 6 children in antibiotic group, 7 children on placebo, evaluated at 10 days when 5/6 treatment and 2/7 placebo group had resolved

Walker 1955Excluded as was using antibiotic prophylactically. Results: no benefit from antibiotics

Wynn-Williams 1961Excluded as participants had complicated past histories for inclusion. Results: 58% reduction in bronchitis in tetracycline group and 49% reduction in the placebo group. The average durations of time off school were 1.9 days and 2.9 days respectively. No statistical testing was reported

 
Comparison 1. Antibiotic versus placebo, common cold

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Persisting symptoms 1 to 7 days61047Risk Ratio (M-H, Random, 95% CI)0.95 [0.59, 1.51]

 2 Persisting symptoms day 1 to 7 with Herne out5979Risk Ratio (M-H, Random, 95% CI)1.11 [0.70, 1.76]

 3 Persisting symptoms days 1 to 7 in adults4891Risk Ratio (M-H, Fixed, 95% CI)0.92 [0.78, 1.07]

 4 Persisting symptoms day 1 to 7 children only2449Risk Ratio (M-H, Fixed, 95% CI)1.36 [0.59, 3.15]

 5 Persisting symptoms day 1 to 7 with Hoagland and McKerrow out3810Risk Ratio (M-H, Fixed, 95% CI)1.00 [0.85, 1.19]

 6 Persisting symptoms 1 to 7 days with Kaiser out5759Risk Ratio (M-H, Random, 95% CI)1.00 [0.45, 2.22]

 7 Adverse effects61495Risk Ratio (M-H, Random, 95% CI)1.80 [1.01, 3.21]

 8 Adverse effects in adults41267Risk Ratio (M-H, Random, 95% CI)2.62 [1.32, 5.18]

 9 Adverse effects in children2228Risk Ratio (M-H, Fixed, 95% CI)0.91 [0.51, 1.63]

 10 Adverse effects with McKerrow out41054Risk Ratio (M-H, Random, 95% CI)1.68 [0.67, 4.20]

 
Comparison 2. Antibiotic versus placebo, clear rhinitis

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Persistent rhinitis (clear) with Herne added as clear2227Risk Ratio (M-H, Random, 95% CI)0.58 [0.23, 1.48]

 
Comparison 3. Antibiotic versus placebo, purulent rhinitis

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Persistent rhinitis (purulent)4723Risk Ratio (M-H, Random, 95% CI)0.73 [0.47, 1.13]

 2 Persistent purulent rhinitis with Herne added as purulent5791Risk Ratio (M-H, Random, 95% CI)0.67 [0.43, 1.04]

 3 Persistent purulent rhinitis with currently available medication4658Risk Ratio (M-H, Random, 95% CI)0.74 [0.46, 1.18]

 4 Adverse effects for purulent rhinitis studies41174Risk Ratio (M-H, Fixed, 95% CI)1.46 [1.10, 1.94]

 
Comparison 4. Antibiotic versus placebo, sore throat

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Sore throat at day 72234Risk Ratio (M-H, Random, 95% CI)0.47 [0.12, 1.82]

 
Comparison 5. Antibiotic versus placebo, work loss

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Any work loss1836Risk Ratio (M-H, Fixed, 95% CI)0.88 [0.69, 1.13]

 
Comparison 6. Antibiotic versus placebo, loss of appetite

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Loss of appetite at day 81188Risk Ratio (M-H, Fixed, 95% CI)0.97 [0.44, 2.12]