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Meta-Analysis
. 2015 May 23;2015(5):CD004783.
doi: 10.1002/14651858.CD004783.pub5.

Antibiotics for acute laryngitis in adults

Ludovic Reveiz  1 , Andrés Felipe Cardona
Affiliations
Meta-Analysis

Antibiotics for acute laryngitis in adults

Ludovic Reveiz et al. Cochrane Database Syst Rev. .

Abstract

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.

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Conflict of interest statement

Ludovic Reveiz: has contributed to this review in a personal capacity and during his spare time. The views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the Pan American Health Organization where he works. Andrés Felipe Cardona: none known.

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 Fusafungine versus fusafungine + clarithromycin, Outcome 1 Clinical cure rates at day 5 ± 1.
1.2
1.2. Analysis
Comparison 1 Fusafungine versus fusafungine + clarithromycin, Outcome 2 Clinical cure rates at day 8 ± 1.
1.3
1.3. Analysis
Comparison 1 Fusafungine versus fusafungine + clarithromycin, Outcome 3 Clinical cure rates at day 28 ± 2.
1.4
1.4. Analysis
Comparison 1 Fusafungine versus fusafungine + clarithromycin, Outcome 4 Frequency of adverse events.
2.1
2.1. Analysis
Comparison 2 Fusafungine versus no treatment, Outcome 1 Clinical cure rates at day 5 ± 1.
2.2
2.2. Analysis
Comparison 2 Fusafungine versus no treatment, Outcome 2 Clinical cure rates at day 8 ± 1.
2.3
2.3. Analysis
Comparison 2 Fusafungine versus no treatment, Outcome 3 Clinical cure rates at day 28 ± 2.
3.1
3.1. Analysis
Comparison 3 Fusafungine + clarithromycin versus no treatment, Outcome 1 Clinical cure rates at day 5 ± 1.
3.2
3.2. Analysis
Comparison 3 Fusafungine + clarithromycin versus no treatment, Outcome 2 Clinical cure rates at day 8 ± 1.
3.3
3.3. Analysis
Comparison 3 Fusafungine + clarithromycin versus no treatment, Outcome 3 Clinical cure rates at day 28 ± 2.
4.1
4.1. Analysis
Comparison 4 Erythromycin versus placebo, Outcome 1 Laryngitis at 1 week.
4.2
4.2. Analysis
Comparison 4 Erythromycin versus placebo, Outcome 2 Laryngitis at 2 week.
4.3
4.3. Analysis
Comparison 4 Erythromycin versus placebo, Outcome 3 Elimination rate of Moraxella catarrhalis at 1 week.
4.4
4.4. Analysis
Comparison 4 Erythromycin versus placebo, Outcome 4 Elimination rate of Moraxella catarrhalis at 2 week.
4.5
4.5. Analysis
Comparison 4 Erythromycin versus placebo, Outcome 5 Patients having voice disturbance at week 1.
4.6
4.6. Analysis
Comparison 4 Erythromycin versus placebo, Outcome 6 Patients having voice disturbance at week 2.
4.7
4.7. Analysis
Comparison 4 Erythromycin versus placebo, Outcome 7 Cough at week 1 (subjective symptom).
4.8
4.8. Analysis
Comparison 4 Erythromycin versus placebo, Outcome 8 Cough at week 2 (subjective symptom).
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References

References to studies included in this review

Rafalskiy 2012 {published data only}
    1. Rafalskiy VV, Gurevitch AS, Otvagin IV, Dovgan EVA. Randomized comparative study of 7‐days courses of fuzafungine vs. fuzafungine and clarithromycin in patients with acute laryngitis. 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) of the American Society for Microbiology. Available at: http://www.icaaconline.com/php/icaac2013abstracts/data/papers/2012/L1/20... (accessed February 3, 2015), 2012; Vol. 52:L1299.
Schalén 1985 {published data only}
    1. Schalén L, Christensen P, Eliasson I, Fex S, Kamme C, Schalen C. Inefficacy of penicillin V in acute laryngitis in adults. Evaluation from results of double‐blind study. Annals of Otology, Rhinology, and Laryngology 1985;94(1 Pt 1):14‐7. - PubMed
Schalén 1993 {published data only}
    1. Schalén L, Eliasson I, Kamme C, Schalen C. Erythromycin in acute laryngitis in adults. Annals of Otology, Rhinology, and Laryngology 1993;102(3 Pt 1):209‐14. - PubMed

References to studies excluded from this review

Schalén 1992 {published data only}
    1. Schalén L, Eliasson I, Fex S, Kamme C, Schalen C. Acute laryngitis in adults: results of erythromycin treatment. Acta Oto‐Laryngologica. Supplement 1992;492:55‐7. - PubMed

Additional references

Altman 1999
    1. Altman DG. Types of data. In: Altman DG editor(s). Practical Statistics for Medical Research. Eighth. Chapman & Hall/CRC, 1999:10‐18.
Arnold 2005
    1. Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database of Systematic Reviews 2005, Issue 4. [DOI: 10.1002/14651858.CD003539.pub2] - DOI - PMC - PubMed
Arroll 2013
    1. Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD000247.pub3] - DOI - PMC - PubMed
Berlin 1997
    1. Berlin J. Does blinding readers affect the results of meta‐analysis? University of Pennsylvania Meta‐analysis Blinding Study Group. Lancet 1997;350:185‐6. - PubMed
Bertino 2002
    1. Bertino JS. Cost burden of viral respiratory infections: issues for formulary decision makers. American Journal of Medicine 2002;112(Suppl 6A):42‐9. - PubMed
Birnbaum 2002
    1. Birnbaum HG, Morley M, Greenberg PE, Colice GL. Economic burden of respiratory infections in an employed population. Chest 2002;122(2):603‐11. - PubMed
Castro 1997
    1. Castro AA, Clark OAC, Atallah A. Optimal search strategy for clinical trials in the Latin American and Caribbean Health Science Literature Database (LILACS). São Paulo Medical Journal 1997;115:1423‐6. - PubMed
Catlin 1990
    1. Catlin BW. Branhamella catarrhalis: an organism gaining respect as a pathogen. Clinical Microbiology Reviews 1990;3:293‐320. - PMC - PubMed
Cherry 2003
    1. Cherry DK, Burt CW, Woodwell DA. National Ambulatory Medical Care Survey: 2001 summary. Advance Data. http://www.cdc.gov/nchs/data/ad/ad338.pdf (accessed 24 September 2003) 2003; Vol. 337:1‐44. - PubMed
Cohen 2012
    1. Cohen SM, Kim J, Roy N, Asche C, Courey M. Direct health care costs of laryngeal diseases and disorders. Laryngoscope 2012;122(7):1582‐8. - PubMed
Danielides 2002
    1. Danielides V, Nousia CS, Patrikakos G, Bartzokas A, Lolis CJ, Milionis HJ, et al. Effect of meteorological parameters on acute laryngitis in adults. Acta Oto‐Laryngologica 2002;122(6):655‐60. - PubMed
DiGiovanni 1987
    1. DiGiovanni C, Riley TV, Hoyne GF, Yeo R, Cooksey P. Respiratory tract infections due to Branhamella catarrhalis: epidemiological data from Western Australia. Epidemiology and Infection 1987;99:445‐53. - PMC - PubMed
Ejlertsen 1994
    1. Ejlertsen T, Thisted E, Ebbesen F, Olesen B, Renneberg J. Branhamella catarrhalis in children and adults. A study of prevalence, time of colonisation, and association with upper and lower respiratory tract infections. Journal of Infection 1994;29:23‐31. - PubMed
FDA 2004
    1. FDA. PCE® (erythromycin particles in tablets). Available at: http://www.fda.gov/medwatch/SAFETY/2004/mar_PI/PCE_PI.pdf (accessed July 2004).
Fung 1991
    1. Fung CP, Powell M, Seymour A, Yuan M, Williams JD. The antimicrobial susceptibility of Moraxella catarrhalis isolated in England and Scotland in 1991. Journal of Antimicrobial Chemotherapy 1992;30:47‐55. - PubMed
Gonzales 2001a
    1. Gonzales R, Bartlett JG, Besser RE, Hickner JM, Hoffman JR, Sande MA, et al. Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: background. Annals of Emergency Medicine 2001;37(6):698‐702. - PubMed
Gonzales 2001b
    1. Gonzales R, Malone DC, Maselli JH, Sande MA. Excessive antibiotic use for acute respiratory infections in the United States. Clinical Infectious Disease 2001;33(6):757‐62. - PubMed
Greiner 2003
    1. Greiner O, Day PJ, Altwegg M, Nadal D. Quantitative detection of Moraxella catarrhalis in nasopharyngeal secretions by real‐time PCR. Journal of Clinical Microbiology 2003;41(4):1386‐90. - PMC - PubMed
Guyatt 2013
    1. Guyatt GH, Oxman AD, Santesso N, Helfand M, Vist G, Kunz R, et al. GRADE guidelines: 12. Preparing summary of findings tables‐binary outcomes. Journal of Clinical Epidemiology 2013;66(2):158‐72. - PubMed
Hashiguchi 1992
    1. Hashiguchi K, Ogawa H, Kazuyama Y. Seroprevalence of Chlamydia pneumoniae infections in otolaryngeal diseases. Journal of Laryngology and Otology 1992;106:208. - PubMed
Higgins 1974
    1. Higgins PB. Viruses associated with acute respiratory infections 1961‐71. Journal of Hygiene 1974;72(3):425‐32. - 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. Chichester, UK: Wiley‐Blackwell, 2011.
Hol 1996
    1. Hol C, Schalen C, Verduin CM, Dijke EE, Verhoef J, Fleer A. Moraxella catarrhalis in acute laryngitis: infection or colonization?. Journal of Infectious Diseases 1996;174(3):636‐8. - PubMed
Jacobs 2004
    1. Jacobs MR, Bajaksouzian S, Windau A, Good CE, Lin G, Pankuch GA, et al. Susceptibility of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis to 17 oral antimicrobial agents based on pharmacodynamic parameters: 1998‐2001 US Surveillance Study. Clinics in Laboratory Medicine 2004;24:503‐30. - PubMed
Jorgensen 1990
    1. Jorgensen JH, Doern GV, Maher LA, Howell AW, Redding JS. Antimicrobial resistance among respiratory isolates of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae in the United States. Antimicrobial Agents and Chemotherapy 1990;34(11):2075‐80. - PMC - PubMed
Koufman 1996
    1. Koufman JA. Infectious and inflammatory diseases of the larynx. In: Ballenger JJ, Snow JB editor(s). Otorhinolaryngology. Fifteenth. Philadelphia: Williams and Wilkins (Lea & Febiger), 1996:535‐55.
Lefevbre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Lemiengre 2012
    1. Lemiengre MB, Driel ML, Merenstein D, Young J, Sutter AI. Antibiotics for clinically diagnosed acute rhinosinusitis in adults. Cochrane Database of Systematic Reviews 2012, Issue 10. [DOI: 10.1002/14651858.CD006089.pub4] - DOI - PubMed
Lund 2004
    1. Lund VJ, Grouin JM, Eccles R, Bouter C, Chabolle F. Efficacy of fusafungine in acute rhinopharyngitis: a pooled analysis. Rhinology 2004;42(4):207‐12. - PubMed
Malmvall 2007
    1. Malmvall BE, Molstad S, Darelid J, Hiselius A, Larsson L, Swanberg J, 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 Jonkoping County, Sweden. Quality Management in Health Care 2007;16(1):60‐7. - PubMed
Mazzaglia 1998
    1. Mazzaglia G, Greco S, Lando C, Cucinotta G, Caputi AP, Mazzaglia G. Adult acute upper respiratory tract infections in Sicily: pattern of antibiotic drug prescription in primary care. Journal of Antimicrobial Chemotherapy 1998;41(2):259‐66. - PubMed
McAuley 2000
    1. McAuley L, Pham B, Tugwell P, Moher D. Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta‐analyses?. Lancet 2000;356:1228‐31. - 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
McCaig 1995
    1. McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office‐based physicians in the United States. JAMA 1995;273(3):214‐9. - 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
Periti 1993
    1. Periti P, Mazzei T, Mini E, Novelli A. Adverse effects of macrolide antibacterials. Drug Safety 1993;9(5):346‐64. - PubMed
Post 1995
    1. Post JC, Preston RA, Aul JJ, Larkins‐Pettigrew M, Rydquist‐White J, Anderson KW, et al. Molecular analysis of bacterial pathogens in otitis media with effusion. JAMA 1995;273:1598‐604. - PubMed
Post 1996
    1. Post JC, White J, Aul JJ, Zavoral T, Wadowsky RM, Zhang Y, 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. Molecular Diagnosis 1996;1:29‐39. - PubMed
Postma 1998
    1. Postma GN, Koufman JA. Laryngitis. In: Bailey BJ editor(s). Head and Neck Surgery ‐ Otolaryngology. Second Edition. Philadelphia: Lippincott‐Raven, 1998:731‐9.
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Schalen 1980
    1. Schalen L, Christensen P, Kamme C, Miorner H, Pettersson KI, Schalen C. High isolation rate of Branhamella catarrhalis from the nasopharynx in adults with acute laryngitis. Scandinavian Journal of Infectious Diseases 1980;12(4):277‐80. - PubMed
Schalen 1988
    1. Schalen L. Acute laryngitis in adults: diagnosis, etiology, treatment. Acta Oto‐Laryngologica 1988;449:31. - PubMed
Spiegel 2000
    1. Spiegel JR, Hawkshaw M, Markiewicz A, Sataloff RT. Acute laryngitis. Ear, Nose, and Throat Journal 2000;79(7):488. - PubMed
Spinks 2013
    1. Spinks A, Glasziou PP, Mar C. Antibiotics for sore throat. Cochrane Database of Systematic Reviews 2013, Issue 11. [DOI: 10.1002/14651858.CD000023.pub4] - DOI - PMC - PubMed
Steinman 2003a
    1. Steinman MA, Landefeld CS, Gonzales R. Predictors of broad‐spectrum antibiotic prescribing for acute respiratory tract infections in adult primary care. JAMA 2003;289(6):719‐25. - PubMed
Steinman 2003b
    1. Steinman MA, Gonzales R, Linder JA, Landefeld CS. Changing use of antibiotics in community‐based outpatient practice, 1991‐1999. Annals of Internal Medicine 2003;138(7):525‐33. - PubMed
Steinman 2009
    1. Steinman MA, Yang KY, Byron SC, Maselli JH, Gonzales R. Variation in outpatient antibiotic prescribing in the United States. American Journal of Managed Care 2009;15(12):861‐8. - PMC - PubMed
Sun 2006
    1. Sun C, Jew S, Dasta SL. Osteopathic physicians in the United States: antibiotic prescribing practices for patients with nonspecific upper respiratory tract infections. Journal of the American Osteopathic Association 2006;106(8):450‐5. - PubMed
Vaughan 1982
    1. Vaughan CW. Current concepts in otolaryngology: diagnosis and treatment of organic voice disorders. New England Journal of Medicine 1982;307(14):863‐6. - PubMed
Verduin 2002
    1. Verduin CM, Hol C, Fleer A, Dijk H, Belkum A. Moraxella catarrhalis: from emerging to established pathogen. Clinical Microbiology Reviews 2002;15(1):125‐44. - PMC - PubMed
Wallace 1990
    1. Wallace RJ, Nash DR, Steingrube VA. Antibiotic susceptibilities and drug resistance in Moraxella (Branhamella) catarrhalis. American Journal of Medicine 1990;88:46S‐50S. - PubMed
Wang 2003
    1. Wang H, Yu YS, Liu Y, Li HY, Hu BJ, Sun ZY, et al. Resistance surveillance of common community respiratory pathogens isolated in China, 2002‐2003 (abstract). Zhonghua Jie He He Hu Xi Za Zhi 2004;27(3):155‐60. - PubMed
WHO 2003
    1. WHO. Upper respiratory tract infections. http://apps.who.int/medicinedocs/en/d/Js5406e/3.html (accessed 24 September 2003) 2003.
WHO 2014
    1. World Health Organization. Antimicrobial resistance: global report on surveillance. Available at http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf (accessed 3 February 2015) 2014.
Wirtz 2010
    1. Wirtz VJ, Dreser A, Gonzales R. Trends in antibiotic utilization in eight Latin American countries, 1997‐2007. Revista Panamericana de Salud Pública 2010;27(3):219‐25. - PubMed

References to other published versions of this review

Ospina 2004
    1. Ospina EG, Reveiz L, Cardona AF, Granados CE, Osorio JV. Antibiotics for acute laryngitis in adults. Cochrane Database of Systematic Reviews 2004, Issue 2. [DOI: 10.1002/14651858.CD004783] - DOI
Reveiz 2005
    1. Reveiz L, Cardona AF, Ospina EG. Antibiotics for acute laryngitis in adults. Cochrane Database of Systematic Reviews 2005, Issue 1. [DOI: 10.1002/14651858.CD004783.pub2] - DOI - PubMed
Reveiz 2007
    1. Reveiz L, Cardona AF, Ospina EG. Antibiotics for acute laryngitis in adults. Cochrane Database of Systematic Reviews 2007, Issue 2. [DOI: 10.1002/14651858.CD004783.pub3] - DOI - PubMed
Reveiz 2009
    1. Reveiz L, Cardona AF, Ospina EG. Antibiotics for acute laryngitis in adults. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD004783.pub3] - DOI - PubMed
Reveiz 2011
    1. Reveiz L, Cardona AF, Ospina EG. Antibiotics for acute laryngitis in adults. Cochrane Database of Systematic Reviews 2011, Issue 5. [DOI: 10.1002/14651858.CD004783.pub3] - DOI
Reveiz 2013
    1. Reveiz L, Cardona AF. Antibiotics for acute laryngitis in adults. Cochrane Database of Systematic Reviews 2013, Issue 3. [DOI: 10.1002/14651858.CD004783.pub4] - DOI - PubMed