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Got It, Hide thisFor acute bronchitis, antibiotics can reduce cough by about half a day but can cause side-effects
Smith SM, Fahey T, Smucny J, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014;3:CD000245.
Review questions
In people with acute bronchitis, do antibiotics improve symptoms? Are there side-effects?
Background
Acute bronchitis, or acute cough, can last for up to 8 weeks. It is usually caused by a virus; sometimes it can be caused by bacteria.
Antibiotics are often prescribed for acute bronchitis, but they won’t work if the bronchitis is caused by a virus. Antibiotics can have side-effects, sometimes serious. Taking antibiotics also increases antibiotic resistance, which means that antibiotics may not work as well in the future.
How the review was done
The researchers did a systematic review, searching for studies available up to January 2014. They found 17 randomized controlled trials with 3936 people, including children, adolescents, and adults.
The key features of the trials were:
- people had acute bronchitis, but not pneumonia or tuberculosis, and had been sick for less than 30 days;
- treatments were antibiotics, including deoxycycline, erythromycin, trimethoprim/sulfamethoxazole, azithromycin, cefuroxime, amoxicillin and co-amoxiclav; and
- treatments were compared with placebo or no treatment.
What the researchers found
The quality of evidence was generally good.
Compared with placebo or control, antibiotics:
- reduced the likelihood of having a cough at 2 to 14 days from 50% to 33%—this means that about 17 fewer people out of 100 had a cough at 2 to 14 days;
- reduced the likelihood of having a night cough at 2 to 14 days from 45% to 30%—this means that about 15 fewer people out of 100 had a night cough at 2 to 14 days;
- reduced the number of hours of cough by 11 hours, although the difference could be as little as 1 hour to as much as 21 hours;
- reduced the number of hours of feeling ill by 15 hours, although the difference could be as little as 3 hours to as much as 28 hours;
- did not increase clinical improvement (having no limitations or being cured or being improved overall); and
- increased side-effects by from 19% to 23%—this means that about 4 more people out of 100 had side-effects (nausea, vomiting, and diarrhea).
Conclusions
In people with acute bronchitis, antibiotics reduce duration of cough and feelings of illness by half a day. They do not increase overall clinical improvement. Side-effects such as nausea, vomiting, and diarrhea are increased.
Antibiotics vs placebo or no treatment in people with acute bronchitis
| Outcomes | Number of trials (people) | Rate of events with antibiotics | Rate of events with placebo or no treatment | Absolute effect of antibiotics at 2 to 14 days |
| Number of people with cough | 4 trials (275 people) | 33% | 50% | About 17 fewer people out of 100 had a cough |
| Number of people with night cough | 4 trials (538 people) | 30% | 45% | About 15 fewer people out of 100 had a night cough |
| Clinical improvement (having no limitations or being cured or being improved overall) | 11 trials (3,841 people) | 73% | 67% | No effect* |
| Side-effects | 12 trials (3,496 people) | 23% | 19% | About 4 more people out of 100 had side-effects |
Related Topics
Glossary
A harmless, inactive, and simulated treatment.
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
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