Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults

BMJ 1998;316:906-910 ( 21 March )

General Practice

Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults

Tom Fahey, senior lecturer, ^a Nigel Stocks, clinical lecturer, ^a Toby Thomas, medical student. ^b

^a Division of Primary Care, University of Bristol, Canynge Hall, Bristol BS8 2PR, ^b United Medical and Dental Schools of Guy's and St Thomas's Hospitals, London SE11 6SP

Correspondence to: Dr Fahey tom.fahey{at}bris.ac.uk

Objectives: To assess whether antibiotic treatment for acute cough is effective and to measure the side effects ofsuch treatment.
Design: Quantitative systematic review of randomised placebo controlled trials.
Data sources: Nine trials (8 published, 1 unpublished) retrieved from a systematic search (electronic databases, contactwith authors, contact with drug manufacturers, reference lists);no restriction on language.
Main outcome measures: Proportion of subjects with productive cough at follow up (7-11 days after consultation withgeneral practitioner); proportion of subjects who had not improvedclinically at follow up; proportion of subjects who reported sideeffects from taking antibiotic or placebo.
Results: Eight trials contributed to the meta-analysis. Resolution of cough was not affected by antibiotic treatment(relative risk 0.85 (95% confidence interval 0.73 to 1.00)), neitherwas clinical improvement at re-examination (relative risk 0.62(0.36 to 1.09)). The side effects of antibiotic were more commonin the antibiotic group when compared to placebo (relative risk1.51 (0.86 to 2.64)).
Conclusions: Treatment with antibiotic does not affect the resolution of cough or alter the course of illness. Thebenefits of antibiotic treatment are marginal for most patientswith acute cough and may be outweighed by the side effects oftreatment.

Key messages

Acute cough, with or without sputum, is a common reason for consulting a general practitioner
Although antibiotic treatment is common for this condition, its likely benefits and side effects have not been measured
This systematic review reports the outcome of nine randomised controlled trials that compared antibiotic with placebo in patients with acute cough
Resolution of cough and clinical improvement at follow up was no different in the two groups
The benefits of antibiotic treatment seem to be marginal for most patients with acute cough and may be outweighed by the side effects of treatment

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