Blog | Thursday, October 10, 2013

QD: News Every Day--NSAIDs, antibiotics make little difference for cough in acute bronchitis

Neither antibiotics nor NSAIDs reduced the number of days of coughing among patients with uncomplicated acute bronchitis, a study found.

Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended mainly for relieving fever, chest pain and cough. And, researchers noted, while most lower respiratory tract infections are viral in nature, antibiotics continue to be overprescribed.

To assess whether either of these two common regimens work in patients with uncomplicated acute bronchitis and discolored sputum, researchers designed a parallel, single-blinded, placebo-controlled, randomized trial at 9 primary care centers in Spain.

Adult patients with a respiratory tract infection of less than one week’s duration, with cough as the predominant symptom, discolored sputum, and at least one other symptom of lower respiratory tract infection such as dyspnea, wheezing, chest discomfort or chest pain, were randomized to receive either ibuprofen 600 mg three times daily, amoxicillin-clavulanic acid 500 mg/125 mg three times daily, or placebo for 10 days.

Results appeared online Oct. 4 at BMJ.

Among the 416 participants randomized (136 to ibuprofen, 137 to antibiotic, and 143 to placebo), 390 returned fully completed symptom diaries. The median number of days with frequent cough was slightly lower among patients assigned to ibuprofen (9 days, 95% CI, 8 to 10 days) vs. those receiving antibiotics (11 days, 95% CI, 10 to 12 days) or placebo (11 days, 95% CI, 8 to 14 days). The differences were not statistically significant. Compared with placebo, the probability of cough resolution did not increase from antibiotics (hazard ratio, 1.03, 95% CI, 0.78 to 1.35) or NSAIDs (HR, 1.23, 95% CI, 0.93 to 1.61).

Adverse events were more common in the antibiotic arm (12%) than ibuprofen or placebo arms (5% and 3%, respectively; P<0.01). 27 patients reported 34 adverse events, including 27 gastrointestinal events, 2 suspected allergic reactions, and 5 other reasons. In the antibiotic group, 16 (12%) reported an adverse event compared to 7 (5%) who received ibuprofen or 4 (3%) who received placebo (P=0.008). 1 patient in the antibiotic group had a digestive hemorrhage that required an ICU admission.