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Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults (Review)

Chang, Christina C., Cheng, Allen C. and Chang, Anne B. (2012). Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults (Review). Cochrane Database of Systematic Reviews,2012(2):1-35.

Document type: Journal Article
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IRMA ID cmartelxPUB8
NHMRC Grant No. 545216
Title Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults (Review)
Author Chang, Christina C.
Cheng, Allen C.
Chang, Anne B.
Journal Name Cochrane Database of Systematic Reviews
Publication Date 2012
Volume Number 2012
Issue Number 2
ISSN 1469-493X   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84861313385
Start Page 1
End Page 35
Total Pages 35
Place of Publication United Kingdom
Publisher John Wiley & Sons Ltd.
HERDC Category C1 - Journal Article (DIISR)
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 the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1966 to July week 4, 2011), OLDMEDLINE (1950 to 1965), EMBASE (1980 to August 2011), CINAHL (2009 to August 2011), LILACS (2009 to August 2011) and Web of Science (2009 to August 2011).

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 using standard methods.

Main results
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).

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.

DOI http://dx.doi.org/10.1002/14651858.CD006088.pub3   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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