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Antibiotics for acute bronchitis - PubMed

  • ️Sun Jan 01 2017

Review

Antibiotics for acute bronchitis

Susan M Smith et al. Cochrane Database Syst Rev. 2017.

Abstract

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 to assess adverse effects of antibiotic therapy for people with a clinical diagnosis of acute bronchitis.

Search methods: We searched CENTRAL 2016, Issue 11 (accessed 13 January 2017), MEDLINE (1966 to January week 1, 2017), Embase (1974 to 13 January 2017), and LILACS (1982 to 13 January 2017). We searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 5 April 2017.

Selection criteria: Randomised controlled trials comparing any antibiotic therapy with placebo or no treatment in acute bronchitis or acute productive cough, in people without underlying pulmonary disease.

Data collection and analysis: At least two review authors extracted data and assessed trial quality.

Main results: We did not identify any new trials for inclusion in this 2017 update. We included 17 trials with 5099 participants in the primary analysis. The quality of trials was generally good. At follow-up there was no difference in participants described as being clinically improved between the antibiotic and placebo groups (11 studies with 3841 participants, risk ratio (RR) 1.07, 95% confidence interval (CI) 0.99 to 1.15). Participants given antibiotics were less likely to have a cough (4 studies with 275 participants, RR 0.64, 95% CI 0.49 to 0.85; number needed to treat for an additional beneficial outcome (NNTB) 6) and a night cough (4 studies with 538 participants, RR 0.67, 95% CI 0.54 to 0.83; NNTB 7). Participants given antibiotics had a shorter mean cough duration (7 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 participants were more likely to be improved according to clinician's global assessment (6 studies with 891 participants, RR 0.61, 95% CI 0.48 to 0.79; NNTB 11) and were less likely to have an abnormal lung exam (5 studies with 613 participants, RR 0.54, 95% CI 0.41 to 0.70; NNTB 6). Antibiotic-treated participants also had a reduction in days feeling ill (5 studies with 809 participants, MD -0.64 days, 95% CI -1.16 to -0.13) and days with impaired activity (6 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 harmful outcome 24).

Authors' conclusions: There is limited evidence of clinical benefit 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.

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Conflict of interest statement

Susan M Smith: None known. Tom Fahey: None known. John Smucny: None known. Lorne A Becker: None known.

Figures

1
1

'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study.

2
2

'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

3
3

Forest plot of comparison: Cough at follow‐up visit, outcome: number of participants with cough.

4
4

Forest plot of comparison: 8 Days of cough, outcome: mean number of days of cough.

5
5

Forest plot of comparison: Clinically improved, outcome: number of participants reporting no limitations or described as cured/well/symptoms resolved or globally improved.

6
6

Forest plot of comparison: Days of feeling ill, outcome: mean number of days of feeling ill.

7
7

Forest plot of comparison: Not improved by physician's global assessment at follow‐up visit, outcome: number of participants not improved.

8
8

Forest plot of comparison: Number of participants with adverse effects.

Update of

  • Antibiotics for acute bronchitis.

    Smith SM, Fahey T, Smucny J, Becker LA. Smith SM, et al. Cochrane Database Syst Rev. 2014 Mar 1;(3):CD000245. doi: 10.1002/14651858.CD000245.pub3. Cochrane Database Syst Rev. 2014. PMID: 24585130 Updated. Review.

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