Antibiotics for acute laryngitis in adults

Background

Acute laryngitis is a common illness worldwide. Diagnosis is often made by case history alone and treatment is often directed toward controlling symptoms.

Objectives

The aim of this review was to assess the effectiveness and safety of different antibiotic therapies in adults with acute laryngitis.

Search strategy

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, issue 4) (including the Acute Respiratory Infections Group's Specialized Register); MEDLINE (January 1966 to November Week 2 2008); EMBASE (1974 to November 2008), LILACS (from 1982 to November 2008 ) and BIOSIS (1980 to November 2008).

Selection criteria

Randomized controlled trials (RCTs) comparing any antibiotic therapy with placebo in acute laryngitis. The main outcome was objective voice scores.

Data collection and analysis

Two review authors independently extracted and descriptively synthesized data.

Main results

Only two trials met the study inclusion criteria after extensive literature searches. One hundred participants were randomly selected to receive either penicillin V (800 mg twice a day for five days), or an identical placebo, in a study of acute laryngitis in adults. A tape recording of each patient reading a standardized text was obtained during the first visit, subsequently 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.

The second trial investigated erythromycin for treating 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 control and intervention groups. At one week there were significant beneficial differences in the severity of reported vocal symptoms as judged by the participants (P = 0.042). Comparing the erythromycin and placebo groups on subjective voice scores, the a priori relative risk (RR) was 0.7 (95% confidence interval (CI) 0.51 to 0.96, P = 0.034) and the number needed to treat (NNT) was 4.5.

Authors' conclusions

Antibiotics appear to have no benefit in treating acute laryngitis. Erythromycin could reduce voice disturbance at one week and cough at two weeks when measured subjectively. We consider that these outcomes are not relevant in clinical practice. The implications for practice are that prescribing antibiotics should not be done in the first instance as they will not objectively improve symptoms.