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Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults.
Cochrane Database Syst Rev 2014; (3):CD006088CD

Abstract

BACKGROUND

Cough is often distressing for patients with pneumonia. Accordingly they often use over-the-counter (OTC) cough medications (mucolytics or cough suppressants). These might provide relief in reducing cough severity, but suppression of the cough mechanism might impede airway clearance and cause harm.

OBJECTIVES

To evaluate the efficacy of OTC cough medications as an adjunct to antibiotics in children and adults with pneumonia.

SEARCH METHODS

We searched CENTRAL 2013, Issue 12, MEDLINE (January 1966 to January week 2, 2014), OLDMEDLINE (1950 to 1965), EMBASE (1980 to January 2014), CINAHL (2009 to January 2014), LILACS (2009 to January 2014) and Web of Science (2009 to January 2014).

SELECTION CRITERIA

Randomised controlled trials (RCTs) in children and adults comparing any type of OTC cough medication with placebo, or control medication, with cough as an outcome and where the cough is secondary to acute pneumonia.

DATA COLLECTION AND ANALYSIS

We independently selected trials for inclusion. We extracted data from these studies, assessed them for methodological quality without disagreement and analyzed them using standard methods.

MAIN RESULTS

There are no new trials to include in this review update. Previously, four studies with a total of 224 participants were included; one was performed exclusively in children and three in adolescents or adults. One using an antitussive had no extractable pneumonia-specific data. Three different mucolytics (bromhexine, ambroxol, neltenexine) were used in the remaining studies, of which only two had extractable data. They demonstrated no significant difference for the primary outcome of 'not cured or not improved' for mucolytics. A secondary outcome of 'not cured' was reduced (odds ratio (OR) for children 0.36, 95% confidence interval (CI) 0.16 to 0.77; number needed to treat to benefit (NNTB) at day 10 = 5 (95% CI 3 to 16) and OR 0.32 for adults (95% CI 0.13 to 0.75); NNTB at day 10 = 5 (95% CI 3 to 19)). In a post hoc analysis combining data for children and adults, again there was no difference in the primary outcome of 'not cured or not improved' (OR 0.85, 95% CI 0.40 to 1.80) although mucolytics reduced the secondary outcome 'not cured' (OR 0.34, 95% CI 0.19 to 0.60; NNTB 4, 95% CI 3 to 8). The risk of bias was low or unclear.

AUTHORS' CONCLUSIONS

There is insufficient evidence to decide whether OTC medications for cough associated with acute pneumonia are beneficial. Mucolytics may be beneficial but there is insufficient evidence to recommend them as an adjunctive treatment for acute pneumonia. This leaves only theoretical recommendations that OTC medications containing codeine and antihistamines should not be used in young children.

Authors+Show Affiliations

Department of Infectious Diseases, The Alfred Hospital, Monash University, Commercial Road, Prahran, Victoria, Australia, 3181.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

24615334

Citation

Chang, Christina C., et al. "Over-the-counter (OTC) Medications to Reduce Cough as an Adjunct to Antibiotics for Acute Pneumonia in Children and Adults." The Cochrane Database of Systematic Reviews, 2014, p. CD006088.
Chang CC, Cheng AC, Chang AB. Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. Cochrane Database Syst Rev. 2014.
Chang, C. C., Cheng, A. C., & Chang, A. B. (2014). Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. The Cochrane Database of Systematic Reviews, (3), p. CD006088. doi:10.1002/14651858.CD006088.pub4.
Chang CC, Cheng AC, Chang AB. Over-the-counter (OTC) Medications to Reduce Cough as an Adjunct to Antibiotics for Acute Pneumonia in Children and Adults. Cochrane Database Syst Rev. 2014 Mar 10;(3)CD006088. PubMed PMID: 24615334.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. AU - Chang,Christina C, AU - Cheng,Allen C, AU - Chang,Anne B, Y1 - 2014/03/10/ PY - 2014/3/12/entrez PY - 2014/3/13/pubmed PY - 2014/10/1/medline SP - CD006088 EP - CD006088 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: Cough is often distressing for patients with pneumonia. Accordingly they often use over-the-counter (OTC) cough medications (mucolytics or cough suppressants). These might provide relief in reducing cough severity, but suppression of the cough mechanism might impede airway clearance and cause harm. OBJECTIVES: To evaluate the efficacy of OTC cough medications as an adjunct to antibiotics in children and adults with pneumonia. SEARCH METHODS: We searched CENTRAL 2013, Issue 12, MEDLINE (January 1966 to January week 2, 2014), OLDMEDLINE (1950 to 1965), EMBASE (1980 to January 2014), CINAHL (2009 to January 2014), LILACS (2009 to January 2014) and Web of Science (2009 to January 2014). SELECTION CRITERIA: Randomised controlled trials (RCTs) in children and adults comparing any type of OTC cough medication with placebo, or control medication, with cough as an outcome and where the cough is secondary to acute pneumonia. DATA COLLECTION AND ANALYSIS: We independently selected trials for inclusion. We extracted data from these studies, assessed them for methodological quality without disagreement and analyzed them using standard methods. MAIN RESULTS: There are no new trials to include in this review update. Previously, four studies with a total of 224 participants were included; one was performed exclusively in children and three in adolescents or adults. One using an antitussive had no extractable pneumonia-specific data. Three different mucolytics (bromhexine, ambroxol, neltenexine) were used in the remaining studies, of which only two had extractable data. They demonstrated no significant difference for the primary outcome of 'not cured or not improved' for mucolytics. A secondary outcome of 'not cured' was reduced (odds ratio (OR) for children 0.36, 95% confidence interval (CI) 0.16 to 0.77; number needed to treat to benefit (NNTB) at day 10 = 5 (95% CI 3 to 16) and OR 0.32 for adults (95% CI 0.13 to 0.75); NNTB at day 10 = 5 (95% CI 3 to 19)). In a post hoc analysis combining data for children and adults, again there was no difference in the primary outcome of 'not cured or not improved' (OR 0.85, 95% CI 0.40 to 1.80) although mucolytics reduced the secondary outcome 'not cured' (OR 0.34, 95% CI 0.19 to 0.60; NNTB 4, 95% CI 3 to 8). The risk of bias was low or unclear. AUTHORS' CONCLUSIONS: There is insufficient evidence to decide whether OTC medications for cough associated with acute pneumonia are beneficial. Mucolytics may be beneficial but there is insufficient evidence to recommend them as an adjunctive treatment for acute pneumonia. This leaves only theoretical recommendations that OTC medications containing codeine and antihistamines should not be used in young children. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/24615334/Over_the_counter__OTC__medications_to_reduce_cough_as_an_adjunct_to_antibiotics_for_acute_pneumonia_in_children_and_adults_ L2 - https://doi.org/10.1002/14651858.CD006088.pub4 DB - PRIME DP - Unbound Medicine ER -