Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Jun 4;2013(6):CD000247.
doi: 10.1002/14651858.CD000247.pub3.

Antibiotics for the common cold and acute purulent rhinitis

Tim Kenealy  1 , Bruce Arroll
Affiliations
Meta-Analysis

Antibiotics for the common cold and acute purulent rhinitis

Tim Kenealy et al. Cochrane Database Syst Rev. .

Abstract

Background: It has long been believed that antibiotics have no role in the treatment of common colds yet they are often prescribed in the belief that they may prevent secondary bacterial infections.

Objectives: To determine the efficacy of antibiotics compared with placebo for reducing general and specific nasopharyngeal symptoms of acute upper respiratory tract infections (URTIs) (common colds).To determine if antibiotics have any influence on the outcomes for acute purulent rhinitis and acute clear rhinitis lasting less than 10 days before the intervention.To determine whether there are significant adverse outcomes associated with antibiotic therapy for participants with a clinical diagnosis of acute URTI or acute purulent rhinitis.

Search methods: For this 2013 update we searched CENTRAL 2013, Issue 1, MEDLINE (March 2005 to February week 2, 2013), EMBASE (January 2010 to February 2013), CINAHL (2005 to February 2013), LILACS (2005 to February 2013) and Biosis Previews (2005 to February 2013).

Selection criteria: Randomised controlled trials (RCTs) comparing any antibiotic therapy against placebo in people with symptoms of acute upper respiratory tract infection for less than seven days, or acute purulent rhinitis less than 10 days in duration.

Data collection and analysis: Both review authors independently assessed trial quality and extracted data.

Main results: This updated review included 11 studies. Six studies contributed to one or more analyses related to the common cold, with up to 1047 participants. Five studies contributed to one or more analyses relating to purulent rhinitis, with up to 791 participants. One study contributed only to data on adverse events and one met the inclusion criteria but reported only summary statistics without providing any numerical data that could be included in the meta-analyses. Interpretation of the combined data is limited because some studies included only children, or only adults, or only males; a wide range of antibiotics were used and outcomes were measured in different ways. There was a moderate risk of bias because of unreported methods details or because an unknown number of participants were likely to have chest or sinus infections.Participants receiving antibiotics for the common cold did no better in terms of lack of cure or persistence of symptoms than those on placebo (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.59 to 1.51, (random-effects)), based on a pooled analysis of six trials with a total of 1047 participants. The RR of adverse effects in the antibiotic group was 1.8, 95% CI 1.01 to 3.21, (random-effects). Adult participants had a significantly greater risk of adverse effects with antibiotics than with placebo (RR 2.62, 95% CI 1.32 to 5.18) (random-effects) while there was no greater risk in children (RR 0.91, 95% CI 0.51 to 1.63).The pooled RR for persisting acute purulent rhinitis with antibiotics compared to placebo was 0.73 (95% CI 0.47 to 1.13) (random-effects), based on four studies with 723 participants. There was an increase in adverse effects in the studies of antibiotics for acute purulent rhinitis (RR 1.46, 95% CI 1.10 to 1.94).

Authors' conclusions: There is no evidence of benefit from antibiotics for the common cold or for persisting acute purulent rhinitis in children or adults. There is evidence that antibiotics cause significant adverse effects in adults when given for the common cold and in all ages when given for acute purulent rhinitis. Routine use of antibiotics for these conditions is not recommended.

PubMed Disclaimer

Conflict of interest statement

There are no known conflicts of interest.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Antibiotic versus placebo, common cold, Outcome 1 Persisting symptoms 1 to 7 days.
1.2
1.2. Analysis
Comparison 1 Antibiotic versus placebo, common cold, Outcome 2 Persisting symptoms day 1 to 7 with Herne out.
1.3
1.3. Analysis
Comparison 1 Antibiotic versus placebo, common cold, Outcome 3 Persisting symptoms days 1 to 7 in adults.
1.4
1.4. Analysis
Comparison 1 Antibiotic versus placebo, common cold, Outcome 4 Persisting symptoms day 1 to 7 children only.
1.5
1.5. Analysis
Comparison 1 Antibiotic versus placebo, common cold, Outcome 5 Persisting symptoms day 1 to 7 with Hoagland and McKerrow out.
1.6
1.6. Analysis
Comparison 1 Antibiotic versus placebo, common cold, Outcome 6 Persisting symptoms 1 to 7 days with Kaiser out.
1.7
1.7. Analysis
Comparison 1 Antibiotic versus placebo, common cold, Outcome 7 Adverse effects.
1.8
1.8. Analysis
Comparison 1 Antibiotic versus placebo, common cold, Outcome 8 Adverse effects in adults.
1.9
1.9. Analysis
Comparison 1 Antibiotic versus placebo, common cold, Outcome 9 Adverse effects in children.
1.10
1.10. Analysis
Comparison 1 Antibiotic versus placebo, common cold, Outcome 10 Adverse effects with McKerrow out.
2.1
2.1. Analysis
Comparison 2 Antibiotic versus placebo, clear rhinitis, Outcome 1 Persistent rhinitis (clear) with Herne added as clear.
3.1
3.1. Analysis
Comparison 3 Antibiotic versus placebo, purulent rhinitis, Outcome 1 Persistent rhinitis (purulent).
3.2
3.2. Analysis
Comparison 3 Antibiotic versus placebo, purulent rhinitis, Outcome 2 Persistent purulent rhinitis with Herne added as purulent.
3.3
3.3. Analysis
Comparison 3 Antibiotic versus placebo, purulent rhinitis, Outcome 3 Persistent purulent rhinitis with currently available medication.
3.4
3.4. Analysis
Comparison 3 Antibiotic versus placebo, purulent rhinitis, Outcome 4 Adverse effects for purulent rhinitis studies.
4.1
4.1. Analysis
Comparison 4 Antibiotic versus placebo, sore throat, Outcome 1 Sore throat at day 7.
5.1
5.1. Analysis
Comparison 5 Antibiotic versus placebo, work loss, Outcome 1 Any work loss.
6.1
6.1. Analysis
Comparison 6 Antibiotic versus placebo, loss of appetite, Outcome 1 Loss of appetite at day 8.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

De Sutter 2002 {published data only}
    1. Sutter AI, Meyere MJ, Christiaens TC, Duriel ML, Peersman W, Maeseneer JM. Does amoxicillin improve outcomes in patients with purulent rhinorrhea?. Journal of Family Practice 2002;51:317‐23. - PubMed
Gordon 1974 {published data only}
    1. Gordon M, Lovell S, Dugdale AE. The value of antibiotics in minor respiratory illness in children. Medical Journal of Australia 1974;1:304‐6. - PubMed
Herne 1980 {published data only}
    1. Herne N. Double blinded randomized trial comparing xibornol, tetracycline and placebo in seasonal upper respiratory tract infections [Essai comparatif en doble aveugle randomise xibornol, tetracycline et placebo dans les infections saisonnieres des vioes aeriennes superiours]. Medicines et Maladies Infectieuses 1980;10:185‐90.
Hoaglund 1950 {published data only}
    1. Hoaglund RJ, Dietz EN, Myers PW, Cosand HC. Aureomycin in the treatment of the common cold. New England Journal of Medicine 1950;243:773‐5. - PubMed
Howie 1970 {published data only}
    1. Howie JG, Clark GA. Double‐blind trial of early demethylchlortetracycline in minor respiratory illness in general practice. Lancet 1970;2:1099‐102. - PubMed
Kaiser 1996 {published data only}
    1. Kaiser L, Lew D, Hirshel B, Auckenthaler R, Morabia A, Heald A, et al. Effects of antibiotic treatment in the subset of common‐cold patients who have bacteria in nasopharyngeal secretions. Lancet 1996;1996:1507‐10. - PubMed
Lexomboon 1971 {published data only}
    1. Lexomboon U, Duangmani C, Kusalasai V, Sunakorn P, Olson LC, Noyes HE. Evaluation of orally administered antibiotics for treatment of upper respiratory infections in Thai children. Journal of Pediatrics 1971;78:772‐8. - PubMed
McKerrow 1961 {published data only}
    1. McKerrow CB, Oldham PD, Thomson S. Antibiotics and the common cold. Lancet 1961;1:185‐7.
Taylor 1977 {published data only}
    1. Taylor B, Abbott GD, Kerr MM. Amoxycillin and co‐trimoxazole in presumed viral respiratory infections in childhood: a placebo controlled trial. BMJ 1977;2:552‐4. - PMC - PubMed
Todd 1984 {published data only}
    1. Todd JK, Todd N, Damanto J, Todd WA. Bacteriology and treatment of purulent nasopharyngitis: a double blind, placebo‐controlled evaluation. Pediatric Infectious Diseases 1984;3:226‐32. - PubMed
Vogt 1966 {published data only}
    1. Vogt FC. Medical management of purulent rhinitis. A double‐blind comparison of vasoconstrictor agent alone with a combination of vasoconstrictor and antimicrobial drugs. Clinical Pediatrics 1966;5(9):547‐9. - PubMed

References to studies excluded from this review

Ackerman 1968 {published data only}
    1. Ackerman BD. Treatment of undifferentiated respiratory infections in infants. Clinical Pediatrics 1968;7:391‐5. - PubMed
Banks 1965 {published data only}
    1. Banks HS. Common cold: controlled clinical trials. British Medical Journal 1965;2:650. - PMC - PubMed
Banks 1969 {published data only}
    1. Banks HS, Ritchies JM. Re‐appraisal: a new look at the common cold. Journal of the Royal College of General Practitioners 1969;18:166‐72. - PMC - PubMed
Bateson 1961 {published data only}
    1. Bateson PR, Allison RM, Wall T, Sons. The treatment of the common cold with antibiotics in a factory population. British Journal of Clinical Practice 1961;15:543‐9. - PubMed
Bessel‐Lorck 1959 {published data only}
    1. Bessel‐Lorck. Prophylaxis for common cold in adolescents in a skiing camp. Die Medizinische Welt 1959;10:2126‐7. - PubMed
Burke 1956 {published data only}
    1. Burke JB. Prophylactic sulphadimidine in children subject to recurrent infections of upper respiratory tract. British Medical Journal 1956;March 10:538‐41. - PMC - PubMed
Cronk 1954 {published data only}
    1. Cronk GO, Naumann DE, McDermott K. A controlled study of oral penicillin G in the treatment of non‐specific upper respiratory infections. American Journal of Medicine 1954;16:804‐9. - PubMed
Darelid 1993 {published data only}
    1. Darelid J, Lofgren S, Malmvall BE. Erythromycin treatment is beneficial for longstanding Moraxella catarrhalis associated cough in children. Scandinavian Journal of Infectious Diseases 1993;25:323‐9. - PubMed
Fraser 1962 {published data only}
    1. Fraser PK, Hatch LA, Hughes KEA. A comparison between aspirin and antibiotics in the treatment of minor respiratory infections. Lancet 1962;1:614‐7. - PubMed
Gottfarb 1994 {published data only}
    1. Gottfarb P, Bruaner A. Children with persistent cough‐outcome with treatment and role of Moraxella catarrhalis. Scandinavian Journal of Infectious Diseases 1994;26:545‐51. - PubMed
Gupta 1997 {published data only}
    1. Gupta S, Bhushan V, Srivastava G. The therapeutic trial of chloramphenicol, Eskaycillin (ampicillin) and co‐trimoxazole in respiratory tract infection of childhood. Indian Paediatrics 1977;14:391‐3. - PubMed
Haight 1954 {published data only}
    1. Haight TH, Kahn FH, Ziegra SR. Efficacy of erythromycin in the treatment of acute respiratory infections. US Armed Forces Medical Journal 1954;5:1405‐22. - PubMed
Hardy 1956 {published data only}
    1. Hardy LM, Traismam HS. Antibiotics and chemotherapeutic agents in the treatment of uncomplicated respiratory infections in children. Journal of Pediatrics 1956;48:146‐56. - PubMed
Haye 1998 {published data only}
    1. Haye R, Lingaas E, Hoivik HO, Odegard T. Azithromycin versus placebo in acute infectious rhinitis with clinical symptoms but without radiological signs of maxillary sinusitis. European Journal of Clinical Microbiology and Infectious Diseases 1998;17:309‐12. - PubMed
Jones 1953 {published data only}
    1. Jones PN, Bigham RS Jr, Manning PR. Use of antibiotics in nonbacterial respiratory infections. Journal of the American Medical Association 1953;153(4):262‐4. - PubMed
Knox 1962 {published data only}
    1. Knox JDE. Comparison between aspirin and anti‐biotics in minor respiratory infections. Lancet 1962;1:1358‐9. - PubMed
Kuh 1949 {published data only}
    1. Kuh C, Collen MF. Mass penicillin prophylaxis: an experiment with negative results. Journal of the American Medical Association 1949;140:1324‐8. - PubMed
Lapin 1984 {published data only}
    1. Lapin JH. Prophylaxis of upper respiratory infections in children treated with oral penicillin. Journal of Pediatrics 1948;32:119‐24. - PubMed
Lockhart 1961 {published data only}
    1. Lockhart R. Treatment of common cold by Terramycin. Health Bulletin 1961;19:12‐3.
Marlow 1989 {published data only}
    1. Marlow RA, Torrez AJ, Haxby D. The treatment of non‐streptococcal pharyngitis with erythromycin. A preliminary study. Family Medicine 1989;21:425‐7. - PubMed
McLane 1952 {published data only}
    1. McLane RA. Clinical evaluation of combined drug therapy in acute upper respiratory infections. Journal of the Medical Society of New Jersey 1952;49:509‐10. - PubMed
Reinert 1991 {published data only}
    1. Reinert P, Narcy P, Paliwoda A, Rouffiac E. Evaluation of tisocortal pivalate‐neomycin combination versus a placebo excipient in acute rhinopharyngitis in children. Annals de Pediatrie 1991;38:503‐8. - PubMed
Ritchie 1958 {published data only}
    1. Ritchie JM. Antibiotics in small doses for the common cold. Lancet 1958;1:618‐21. - PubMed
Seal 1953 {published data only}
    1. Seal JR. The prophylaxis of acute respiratory infections with oral penicillin or chlortetracycline ‐ proceedings of the symposium on antibiotics. Antibiotics Annual. Medical Encyclopedia Inc, 1953‐4.
Sulman 1958 {published data only}
    1. Sulman FG. Chloramphenicol and control of the common cold. Lancet 1958;ii:1355‐6.
Sutrisna 1991 {published data only}
    1. Sutrisna B, Freruchs RR, Reingold AL. Randomised controlled trial of effectiveness of ampicillin in mild acute respiratory infections in Indonesian children. Lancet 1991;338:471‐4. - PMC - PubMed
Townsend 1960 {published data only}
    1. Townsend EH. Chemoprophylaxis during respiratory infections in private pediatric practice. American Journal of Diseases in Children 1960;99:566‐73. - PubMed
Townsend 1962 {published data only}
    1. Townsend EH, Radebaugh JF. Prevention of complications of respiratory illness in pediatric practice. New England Journal of Medicine 1962;266:683‐9. - PubMed
Traisman 1955 {published data only}
    1. Traisman HS. A controlled study in the uses of chemotherapeutic and antibiotic agents in uncomplicated upper respiratory infections in children. Illinois Medical Journal 1955;107:221‐4. - PubMed
Wald 1991 {published data only}
    1. Wald ER. Purulent nasal discharge. Pediatric Infectious Diseases Journal 1991;10(4):329‐33. - PubMed
Walker 1955 {published data only}
    1. Walker SH. Tetracycline in the control of upper respiratory infections of infants. Antibiotics Annual. First Edition. New York: Medical Encyclopedia, Inc, 1955‐6:341‐4. - PubMed
Wynn‐Williams 1961 {published data only}
    1. Wynn‐Williams SH. Tetracycline in the control of common upper respiratory infections of infants. Antibiotic Annual. First Edition. New York: Medical Encyclopedia, Inc, 1961:341‐4. - PubMed

Additional references

Arason 1996
    1. Arason A, Kristinsson KG, Sigurdsson JA, Stefansdottir G, Molstad S, Gudmundsson S. Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study. BMJ 1996;313:387‐91. - PMC - PubMed
Arroll 2000
    1. Arroll B, Goodyear‐Smith F. General practitioner management of upper respiratory tract infections: when are antibiotics prescribed?. New Zealand Medical Journal 2000;113:493‐6. - PubMed
Arroll 2001
    1. Arroll B, Kenealy T. Antibiotics for acute bronchitis. Four reviews and still no answers: our clinical definitions are at fault. BMJ 2001;322:939‐40. - PMC - PubMed
Del Mar 1992
    1. Mar C. Managing sore throat: a literature review, II. Do antibiotics confer benefit?. Medical Journal of Australia 1992;156:644‐9. - PubMed
Fahey 1998
    1. Fahey T, Stocks N, Thomas T. Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults. BMJ 1998;316:906‐10. - PMC - PubMed
Gadomski 1993
    1. Gadomski AM. Potential interventions for preventing pneumonia among young children: lack of effect of antibiotic treatment for upper respiratory infections. Pediatric Infectious Disease Journal 1993;12:115‐20. - PubMed
Gonzales 1999
    1. Gonzales R, Barrett P, Steiner J. The relation between purulent manifestations and antibiotic treatment of upper respiratory tract infections. Journal of General Internal Medicine 1999;14:151‐6. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available from www.cochrane‐handbook.org 2011.
ICHPPC 1986
    1. ICHPPC‐2. International Classification of Health Problems in Primary Care. Third Edition. Oxford: Oxford University Press, 1986.
Kaplan 1971
    1. Kaplan EL, Top FH, Dudding BA, Wannamake L. Diagnosis of streptococcal pharyngitis: differentiation of active infection from the carrier state in the symptomatic child. Journal of Infectious Diseases 1971;123:490‐501. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available from www.cochrane‐handbook.org. Chichester: Wiley‐Blackwell, 2011.
Mainous 1997
    1. Mainous AG, Hueston WJ, Eberlain C. Colour of respiratory discharge and antibiotic use. Lancet 1997;350:1077. - PubMed
McAvoy 1994
    1. McAvoy B, Davis P, Raymont A, Gribben B. The Waikato Medical Care Survey. New Zealand Medical Journal 1994;107:387‐433. - PubMed
McGregor 1995
    1. McGregor A, Dovey S, Tilyard M. Antibiotic use in upper respiratory tract infections in New Zealand. Family Practice 1995;12:166‐70. - PubMed
Morris 2007
    1. Morris PS, Leach AJ. Antibiotics for persistent nasal discharge (rhinosinusitis) in children. Cochrane Database of Systematic Reviews 2007, Issue 3. [DOI: 10.1002/14651858.CD001094.pub2] - DOI - PubMed
Ochoa 2000
    1. Ochoa C, Eiros JM, Inglada L, Vallano A, Guerra L. Assessment of antibiotic prescription in acute respiratory infections in adults. The Spanish study group on antibiotic treatment. Journal of Infection 2000;41:73‐80. - PubMed
Pharmac 2008
    1. Pharmac. Annual review. www.pharmac.govt.nz (accessed 5 January 2010) 2008; Vol. section 2:16.
RevMan 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Reynolds 1996
    1. Reynolds JEF, Parfitt K (editors). Martindale: The Extra Pharmacopeia. 1st Edition. London: Royal Pharmaceutical Society, 1996.
Rosenstein 1998
    1. Rosenstein N, Phillips W, Gerber M, Marcy S, Schwartz B, Dowell S. The common cold ‐ principles of judicious use of antimicrobial agents. Pediatrics 1998;101:181‐4.
Smith 2011
    1. Smith S, Fahey T, Smucny J, Becker L. Antibiotics for acute bronchitis. Cochrane Database of Systematic Reviews 2011, Issue 11. [DOI: 10.1002/14651858.CD000245.pub2] - DOI - PubMed
Snow 2001
    1. Snow V, Mottur‐Pilson C, Gonzales R. Principles of appropriate antibiotic use for treatment of non specific upper respiratory tract infections in adults. Annals of Internal Medicine 2001;134:487‐9. - PubMed
Spector 1995
    1. Spector SL. The common cold: current therapy and natural history. Journal of Allergy and Clinical Immunology 1995;95:1133‐8. - PMC - PubMed
Spinks 2011
    1. Spinks A, Glasziou PP, Mar C. Antibiotics for sore throat. Cochrane Database of Systematic Reviews 2011, Issue 9. [DOI: 10.1002/14651858.CD000023.pub3] - DOI - PubMed
Stott 1976
    1. Stott NC, West RR. Randomised controlled trial of antibiotics in patients with cough and purulent sputum. British Medical Journal 1976;2:556‐9. - PMC - PubMed
Venekamp 2013
    1. Venekamp RP, Sanders S, Glasziou PP, Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database of Systematic Reviews 2013, Issue 1. [DOI: 10.1002/14651858.CD000219.pub3] - DOI - PubMed
Verkatesum 1995
    1. Verkatesum P, Innes JA. Antibiotic resistance in common acute respiratory pathogens. Thorax 1995;50:481‐3. - PMC - PubMed

References to other published versions of this review

Arroll 1998
    1. Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews 1998, Issue 4. [DOI: 10.1002/14651858.CD000247.pub2] - DOI - PMC - PubMed
Arroll 2002
    1. Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews 2002, Issue 3. [DOI: 10.1002/14651858.CD000247.pub2] - DOI - PubMed
Arroll 2005
    1. Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews 2005, Issue 3. [DOI: 10.1002/14651858.CD000247.pub2] - DOI - PubMed
Arroll 2010
    1. Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews 2010, Issue 2. [DOI: 10.1002/14651858.CD000247.pub2] - DOI - PubMed

Publication types

Substances