Treatments fail to reduce cough in acute bronchitis patients
Acute bronchitis is one of the most common complaints encountered by primary care physicians. The condition is primarily caused by viral infection and is generally self-limiting, but most patients continue to be prescribed antibiotic treatments, particularly if they report discoloration of sputum. Given the global increase in antibiotic resistance, this over-prescription is of concern. Since cough is the primary symptom of acute bronchitis, oral anti-inflammatory therapy has been suggested as a more appropriate treatment. However, a recent study in Spain has shown that neither oral anti-inflammatory nor antibiotic treatment is more effective than placebo at reducing cough frequency.
The prospective, parallel group, single-blind study included 416 adults aged 18-70 who presented with symptoms of respiratory infection of less than 1 week duration, predominately cough but also sputum discoloration and at least one of the following: dyspnea, wheezing, chest discomfort or chest pain. The patients were randomized to ibuprofen 600 mg three times daily (n=136), amoxicillin-clavulanic acid 500 mg/125 mg three times daily (n=137) or placebo three times daily (n=143) for 10 days. Symptom duration was assessed with a diary.
The median number of days with frequent cough was 9 (95% CI 8–10) among the ibuprofen recipients compared with 11 (95% CI 10-12) among those who received the antibiotic. However, this difference was not statistically significant. Moreover, the probability of cough resolution was not greater than that of placebo for both ibuprofen (hazard ratio [HR] 1.03, 95% CI 0.78–1.35) and amoxicillin-clavulanic acid (HR 1.23, 95% CI 0.93–1.61).
Llor C et al. Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial. BMJ 2013;347:f5762.