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Antibiotics for prolonged moist cough in children (Review)

Marchant, Julie M., Morris, Peter S., Gaffney, Justin and Chang, Anne B. (2005). Antibiotics for prolonged moist cough in children (Review). Cochrane Database of Systematic Reviews,2005(4 - Article No. CD004822).

Document type: Journal Article
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IRMA ID 10559xPUB18
Title Antibiotics for prolonged moist cough in children (Review)
Author Marchant, Julie M.
Morris, Peter S.
Gaffney, Justin
Chang, Anne B.
Journal Name Cochrane Database of Systematic Reviews
Publication Date 2005
Volume Number 2005
Issue Number 4 - Article No. CD004822
eISSN 1469-493X
Total Pages 27
Place of Publication United Kingdom
Publisher John Wiley & Sons Ltd.
Field of Research 1114 - Paediatrics and Reproductive Medicine
HERDC Category C1 - Journal Article (DEST)
Abstract Background
Cough is the most common symptom which presents to doctors. Chronic cough is reported in up to 9% of preschool aged children. American general practice guidelines suggest antimicrobial treatment may be indicated in children with cough lasting longer than 10 days. Questions concerning the benefits and harm of antibiotic treatment for prolonged cough in children need to be resolved.

A Cochrane systematic review was undertaken to determine the efficacy of antibiotics in treating children with chronic moist cough (excluding those with bronchiectasis or other underlying respiratory illnesses).

Search methods

The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE, EMBASE, review articles and reference lists of relevant articles were searched. The latest searches were performed in October 2010.

Selection criteria

All randomised controlled trials (RCTs) comparing antibiotics with a placebo or a control group in children with chronic moist cough were considered.

Data collection and analysis
Results of searches were reviewed against pre-determined criteria for inclusion. Two independent reviewers selected, extracted and assessed the data for inclusion. Authors were contacted for further information. Data were analysed as 'intention to treat'.

Main results

Two studies were eligible for inclusion in the review. Neither study was high quality. Both studies failed to include a prospective analysis of cough quality in their inclusion criteria, although indicating >75% of children included had moist cough (Darelid 1993). A total of 140 patients, aged seven years or less, were included in meta-analysis. Treatment with antibiotics reduced the proportion of children not cured at follow-up (primary outcome measure) in both studies; pooled odds ratio (OR) was 0.13, 95% CI 0.06 to 0.32 (using intention to treat analysis), which translates to number needed to treat (NNT) of 3 (95% CI 2 to 4). No significant heterogeneity was found (fixed and random-effects model I2 was 4%). However for this outcome measure, the overall estimate of effect and degree of statistical heterogeneity were sensitive to the model used for meta-analysis. Progression of illness, defined by requirement for further antibiotics, was significantly lower in the treatment group (OR 0.10, 95%CI 0.03 to 0.34), NNT was 4 (95% CI 3 to 5). Adverse events were not significantly increased in the treatment group.

Authors' conclusions

Antibiotics are likely to be beneficial in the treatment of children with chronic moist cough. This evidence is however limited by study quality, study design and sensitivity analysis data. The use of antibiotics however has to be balanced against their well known adverse events. Further well-designed RCTs using valid cough outcome measures are needed to answer this question conclusively.
Keywords Antibiotics
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