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Antibiotics for acute laryngitis in adults

  • Review
  • Intervention

Authors

  • Ludovic Reveiz,

    Corresponding author
    1. Health Systems Based on Primary Health Care (HSS), Pan American Health Organization, Research Promotion and Development Team, Washington DC, USA
    • Ludovic Reveiz, Research Promotion and Development Team, Health Systems Based on Primary Health Care (HSS), Pan American Health Organization, 525, 23rd St, NW, Washington DC, 20037-2895, USA. mmreveiz@hotmail.com. lreveiz@yahoo.com.

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  • Andrés Felipe Cardona,

    1. Institute of Oncology, Fundación Santa Fe de Bogotá, Clinical and Translational Oncology Group, Bogotá, Cundinamarca, Colombia
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  • Edgar Guillermo Ospina

    1. Edificio de Consultorios Reina Sofía, Bogotá, Colombia
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Abstract

Background

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.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1) which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1966 to January week 3, 2011), EMBASE (1974 to January 2011), LILACS (1982 to January 2011) and BIOSIS (1980 to January 2011).

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 randomized 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 re-examination after one and two weeks, and at follow up 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 re-examination after one and two weeks, and at follow up 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.

摘要

背景

抗生素治療成人急性喉炎(acute laryngitis)

急性喉炎是一種全世界常見的疾病,通常藉由臨床病史來診斷,而治療往往著重於症狀控制。

目標

這篇回顧文章的目的,在於評估不同抗生素用於治療成人急性喉炎的有效性與安全性。

搜尋策略

我們檢索了Cochrane Central Register of Controlled Trials (CENTRAL)(Cochrane圖書館2008年第4期)(包括Acute Respiratory Infection Group Specialized Register)、MEDLIN(1966年1月至2008年11月第2週)、EMBASE(1974年至2008年11月)、LILACS(1982年至2008年11月),以及BIOSIS(1980年至2008年11月)。

選擇標準

收錄比較抗生素與安慰劑用於治療急性喉炎的隨機對照試驗(RCTs);研究的主要結果著眼於客觀的聲音分數。

資料收集與分析

由兩位作者各自擷取並描述性地綜合數據。

主要結論

經過廣泛的文獻檢索之後,只有兩個試驗符合收納的標準。其中第一個試驗包含100名受試者,經由隨機分配之後,分別接受Penicillin V(800毫克,每日2次,共5天)或安慰劑的治療。研究者請受試者閱讀一段標準內容的文章,同時以錄音帶錄音,於第一次訪視、1週後、2週後以及試驗完成後的2到6個月時進行紀錄,並針對症狀進行評估,結果發現並無顯著的差異。第二個試驗以Erythromycin治療患有急性喉炎的106位成年人,之後分別於第一次訪視、1週後、2週後以及試驗完成後的2到6個月時進行追蹤,結果實驗組與對照組的「客觀聲音分數」並沒有顯著的差異,但在1週後的聲音症狀有主觀的改善(P = 0.042)。在比較Erythromycin組和安慰劑組的「主觀聲音分數」之後可發現,前者的relative risk(RR)為0.7(95%CI 0.51~0.96,P = 0.034),需治療人數則為4.5人。

作者結論

抗生素對於治療急性喉炎似乎沒有好處,但Erythromycin可主觀地在第1週減少聲音症狀的困擾,並在第2週主觀地改善咳嗽症狀;然而,我們認為這些結果並不具臨床價值。因為抗生素不能客觀地改善症狀,因此處方抗生素不應做為首選之治療。

翻譯人

本摘要由慈濟醫院陳迪詠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

抗生素治療成人急性喉炎急性喉炎是一種喉部的急性發炎,最常見的症狀是聲音嘶啞、發燒、喉痛、後鼻滴涕以及吞嚥困難。這篇回顧文章發現,Penicillin V和Erythromycin對於治療急性喉炎似乎沒有好處。Erythromycin可主觀地在第1週減少聲音症狀的困擾,並在第2週主觀地改善咳嗽症狀。然而,因為抗生素些微的好處遠不及其成本、副作用、及產生抗藥性的考量,所以我們認為這些結果並不具實際上的臨床價值。

Plain language summary

Antibiotics for adults with acute laryngitis

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 over-prescribing 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 are 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.

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