Antibiotics for acute laryngitis in adults.

BACKGROUND This is an update of the original review published in 2005. Acute laryngitis is a common illness worldwide. Diagnosis is often made by case history alone and treatment often targets 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 (2014, Issue 11), MEDLINE (January 1966 to November week 3, 2014), EMBASE (1974 to December 2014), LILACS (1982 to December 2014) and BIOSIS (1980 to December 2014). 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 synthesised data. MAIN RESULTS We included three RCTs (351 participants) that had moderate to high risk of bias. The quality of the evidence was very low for all outcomes. We downgraded the studies because of limitations in study design or execution (risk of bias), imprecision and inconsistency of results. We included a new trial presented only as a conference abstract in this update.In one study of acute laryngitis in adults, 100 participants were randomised to receive penicillin V (800 mg twice daily for five days) or an identical placebo. A recording of each patient reading a standardised text was made at the first visit, 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.One study investigated erythromycin for 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 the groups. At one week there were significant beneficial differences in the severity of reported vocal symptoms (slight, moderate and severe) as judged by participants (P value = 0.042). However, the rates of participants having improved voice disturbance (subjective symptoms) at one and two weeks were not significantly different among groups. Comparing erythromycin and placebo groups on the rate of persistence of cough at two weeks, the risk ratio (RR) was 0.38 (95% confidence interval (CI) 0.15 to 0.97, P value = 0.04) and the number needed to treat for an additional beneficial outcome (NNTB) was 5.87 (95% CI 3.09 to 65.55). We calculated a RR of 0.64 (95% CI 0.46 to 0.90, P value = 0.034) and a NNTB of 3.76 (95% CI 2.27 to 13.52; P value = 0.01) for the subjective voice scores at one week.A third trial from Russia included 145 patients with acute laryngitis symptoms. Participants were randomised to three treatment groups: Group 1: seven-day course of fusafungine (six times a day by inhalation); Group 2: seven-day course of fusafungine (six times a day by inhalation) plus clarithromycin (250 mg twice daily for seven days); Group 3: no treatment. Clinical cure rates were measured at days 5 ± 1, 8 ± 1 and 28 ± 2. The authors reported significant differences in the rates of clinical cure at day 5 ± 1 favouring fusafungine (one trial; 93 participants; RR 1.50, 95% CI 1.02 to 2.20; P value = 0.04) and fusafungine plus clarithromycin (one trial 97 participants; RR 1.47, 95% CI 1.00 to 2.16; P value = 0.05) when compared to no treatment. However, no significant differences were found at days 8 ± 1 and 28 ± 2. Also, no significant differences were found when comparing fusafungine to fusafungine plus clarithromycin at days 5 ± 1, 8 ± 1 and 28 ± 2. AUTHORS' CONCLUSIONS Antibiotics do not appear to be effective in treating acute laryngitis when assessing objective outcomes. They appear to be beneficial for some subjective outcomes. Erythromycin could reduce voice disturbance at one week and cough at two weeks when measured subjectively. Fusafungine could increase the cure rate at day five. The included RCTs had important methodological problems and these modest benefits from antibiotics may not outweigh their cost, adverse effects or negative consequences for antibiotic resistance patterns.

[1]  M. WoodJohn,et al.  Laryngitis , 2015 .

[2]  B. Arroll,et al.  Antibiotics for the common cold and acute purulent rhinitis. , 2013, The Cochrane database of systematic reviews.

[3]  Gordon H Guyatt,et al.  GRADE guidelines: 12. Preparing summary of findings tables-binary outcomes. , 2013, Journal of clinical epidemiology.

[4]  M. V. van Driel,et al.  Antibiotics for clinically diagnosed acute rhinosinusitis in adults. , 2012, The Cochrane database of systematic reviews.

[5]  C. Asche,et al.  Direct health care costs of laryngeal diseases and disorders , 2012, The Laryngoscope.

[6]  R. Gonzales,et al.  Trends in antibiotic utilization in eight Latin American countries, 1997-2007. , 2010, Revista panamericana de salud publica = Pan American journal of public health.

[7]  Sepheen C. Byron,et al.  Variation in outpatient antibiotic prescribing in the United States. , 2009, The American journal of managed care.

[8]  J. Darelid,et al.  Reduction of antibiotics sales and sustained low incidence of bacterial resistance: Report on a broad approach during 10 years to implement evidence-based indications for antibiotic prescribing in Jönköping County, Sweden. , 2007 .

[9]  Chao Sun,et al.  Osteopathic Physicians in the United States: Antibiotic Prescribing Practices for Patients With Nonspecific Upper Respiratory Tract Infections , 2006, The Journal of the American Osteopathic Association.

[10]  S. Straus,et al.  Interventions to improve antibiotic prescribing practices in ambulatory care. , 2005, The Cochrane database of systematic reviews.

[11]  V. Lund,et al.  Efficacy of fusafungine in acute rhinopharyngitis: a pooled analysis. , 2004, Rhinology.

[12]  M. Jacobs,et al.  Susceptibility of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis to 17 oral antimicrobial agents based on pharmacodynamic parameters: 1998-2001 U S Surveillance Study. , 2004, Clinics in laboratory medicine.

[13]  Ziyong Sun,et al.  [Resistance surveillance of common community respiratory pathogens isolated in China, 2002 - 2003]. , 2004, Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases.

[14]  D. Cherry,et al.  National Ambulatory Medical Care Survey: 2001 summary. , 2003, Advance data.

[15]  D. Nadal,et al.  Quantitative Detection of Moraxella catarrhalis in Nasopharyngeal Secretions by Real-Time PCR , 2003, Journal of Clinical Microbiology.

[16]  J. Linder,et al.  Changing Use of Antibiotics in Community-Based Outpatient Practice, 19911999 , 2003, Annals of Internal Medicine.

[17]  J. Bertino.  Cost burden of viral respiratory infections: Issues for formulary decision makers☆ , 2003 .

[18]  Ralph Gonzales,et al.  Predictors of broad-spectrum antibiotic prescribing for acute respiratory tract infections in adult primary care. , 2003, JAMA.

[19]  Melissa Morley,et al.  Economic burden of respiratory infections in an employed population. , 2002, Chest.

[20]  J. Bertino.  Cost burden of viral respiratory infections: issues for formulary decision makers. , 2002, The American journal of medicine.

[21]  A. van Belkum,et al.  Moraxella catarrhalis: from Emerging to Established Pathogen , 2002, Clinical Microbiology Reviews.

[22]  H. Milionis,et al.  Effect of Meteorological Parameters on Acute Laryngitis in Adults , 2002, Acta oto-laryngologica.

[23]  D. Malone,et al.  Excessive antibiotic use for acute respiratory infections in the United States. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[24]  R. Gonzales,et al.  Principles of Appropriate Antibiotic Use for Treatment of Nonspecific Upper Respiratory Tract Infections in Adults: Background , 2001, Annals of Internal Medicine.

[25]  P. Tugwell,et al.  Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? , 2000, The Lancet.

[26]  R. Sataloff,et al.  Prolonged Ulcerative Laryngitis , 2000, Ear, nose, & throat journal.

[27]  G. Mazzaglia,et al.  Adult acute upper respiratory tract infections in Sicily: pattern of antibiotic drug prescription in primary care. , 1998, The Journal of antimicrobial chemotherapy.

[28]  Jesse A Berlin,et al.  Does blinding of readers affect the results of meta-analyses? , 1997, The Lancet.

[29]  Á. Atallah,et al.  Optimal search strategy for clinical trials in the Latin American and Caribbean Health Science Literature Database (LILACS). , 1997, Sao Paulo medical journal = Revista paulista de medicina.

[30]  J. Verhoef,et al.  Moraxella catarrhalis in acute laryngitis: infection or colonization? , 1996, The Journal of infectious diseases.

[31]  Aul,et al.  Development and Validation of a Multiplex PCR-Based Assay for the Upper Respiratory Tract Bacterial Pathogens Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. , 1996, Molecular diagnosis : a journal devoted to the understanding of human disease through the clinical application of molecular biology.

[32]  S. Dovey,et al.  Antibiotic use in upper respiratory tract infections in New Zealand. , 1995, Family practice.

[33]  L. Kingsley,et al.  Molecular analysis of bacterial pathogens in otitis media with effusion. , 1995, JAMA.

[34]  J. Hughes,et al.  Trends in antimicrobial drug prescribing among office-based physicians in the United States. , 1995, JAMA.

[35]  N. Pearce,et al.  Risk factors for asthma symptoms in Kawerau children. , 1994, The New Zealand medical journal.

[36]  A. Raymont,et al.  The Waikato Medical Care (WaiMedCa) Survey 1991-1992. , 1994, The New Zealand medical journal.

[37]  F. Ebbesen,et al.  Branhamella catarrhalis in children and adults. A study of prevalence, time of colonisation, and association with upper and lower respiratory tract infections. , 1994, The Journal of infection.

[38]  E. Mini,et al.  Adverse Effects of Macrolide Antibacterials , 1993, Drug safety.

[39]  L. Schalén,et al.  Erythromycin in Acute Laryngitis in Adults , 1993, The Annals of otology, rhinology, and laryngology.

[40]  C. Fung,et al.  The antimicrobial susceptibility of Moraxella catarrhalis isolated in England and Scotland in 1991. , 1992, The Journal of antimicrobial chemotherapy.

[41]  K. Hashiguchi,et al.  Seroprevalence of Chlamydia pneumoniae infections in otolaryngeal diseases , 1992, The Journal of Laryngology & Otology.

[42]  G. Doern,et al.  Antimicrobial resistance among respiratory isolates of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae in the United States , 1990, Antimicrobial Agents and Chemotherapy.

[43]  B. Catlin.  Branhamella catarrhalis: an organism gaining respect as a pathogen , 1990, Clinical Microbiology Reviews.

[44]  R. Wallace,,et al.  Antibiotic susceptibilities and drug resistance in Moraxella (Branhamella) catarrhalis. , 1990, The American journal of medicine.

[45]  G. Hoyne,et al.  Respiratory tract infections due to Branhamella catarrhalis: epidemiological data from Western Australia , 1987, Epidemiology and Infection.

[46]  S. Fex,et al.  Inefficacy of Penicillin V in Acute Laryngitis in Adults , 1985, The Annals of otology, rhinology, and laryngology.

[47]  C. Vaughan.  Current concepts in otolaryngology: diagnosis and treatment of organic voice disorders. , 1982, The New England journal of medicine.

[48]  P. Higgins.  Viruses associated with acute respiratory infections 1961–71 , 1974, Journal of Hygiene.

[49]  Derek Richards,et al.  Types of data , 2007, Evidence-Based Dentistry.

[50]  A. Cardona,et al.  Antibiotics for acute laryngitis in adults. , 2005, The Cochrane database of systematic reviews.

[51]  P. Glasziou,et al.  Antibiotics for sore throat. , 2004, The Cochrane database of systematic reviews.

[52]  S. Fex,et al.  Acute laryngitis in adults: results of erythromycin treatment. , 1992, Acta oto-laryngologica. Supplementum.

[53]  L. Schalén.  Acute laryngitis in adults: diagnosis, etiology, treatment. , 1988, Acta oto-laryngologica. Supplementum.

[54]  H. Miörner,et al.  High isolation rate of Branhamella catarrhalis from the nasopharynx in adults with acute laryngitis. , 1980, Scandinavian journal of infectious diseases.