Antibiotics for acute laryngitis in adults

ArticleinCochrane database of systematic reviews (Online) 5(5):CD004783 · May 2015with15 Reads
DOI: 10.1002/14651858.CD004783.pub5 · Source: PubMed
Review questionCochrane authors reviewed the available evidence from randomised controlled trials on the use of antibiotics for adults with acute laryngitis. Background Acute laryngitis is an inflammation of the larynx. The most common symptoms are hoarseness, fever, sore throat, postnasal discharge and difficulty in swallowing. Antibiotics are frequently prescribed by physicians or self prescribed. Reasons for over-prescribing antibiotics in upper respiratory tract infections such as acute laryngitis are varied but they often involve physicians' and patients' attitudes and expectations. Study characteristicsThis review found three studies involving 351 participants evaluating the effectiveness of different antibiotic therapies in adults with acute laryngitis. The evidence is current to December 2014. Quality of the evidenceWe ranked the quality of the evidence as low to very low, mainly because many studies had methodological limitations, outcome results were based on limited numbers of trials and the trials included participants that could not be pooled. Key resultsWe found that penicillin V and erythromycin 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. Fusafungine could improve the rates of cured patients at day five. Overall, there is no clear benefit for the primary outcome, which is an objective assessment of voice quality, but some improvements are seen in subjective measures (i.e. cough, hoarseness of voice) that could be important to patients. However, we consider that these modest benefits from antibiotics may not outweigh their cost, adverse effects or negative consequences for antibiotic resistance patterns. The implications for practice are that prescribing antibiotics should not be done in the first instance as they will not objectively improve symptoms
  • [Show abstract] [Hide abstract] ABSTRACT: Laryngitis describes inflammation of the larynx, and a variety of causes result in the presentation of common symptoms. Laryngitis may be acute or chronic, infective or inflammatory, an isolated disorder, or part of systemic disease, and often includes symptoms such as hoarseness. Commonly, laryngitis is related to an upper respiratory tract infection and can have a major impact on physical health, quality of life, and even psychological wellbeing and occupation if symptoms persist.1 Overall, laryngitis incorporates a cluster of non-specific laryngeal signs and symptoms that can also be caused by other diseases. Consequently diagnosis can be difficult and requires correlation of history, examination, and, if necessary, specialised assessment, including visualisation of the larynx and stroboscopy. Acute laryngitis is typically diagnosed and managed at the primary care level. In at risk populations, or those with persisting symptoms, referral to a specialist otolaryngologist should be considered. The aim of this review is to assist non-specialists in assessing and managing people with laryngitis and to identify the cohort that requires specialist input.
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  • [Show abstract] [Hide abstract] ABSTRACT: Hoarseness (dysphonia) is the reason for about 1% of all consultations in primary care. It has many causes, ranging from self-limited laryngitis to malignant tumors of the vocal cords. This review is based on literature retrieved by a selective search in PubMed employing the terms "hoarseness," "hoarse voice," and "dysphonia," on the relevant guideline of the American Academy of Otolaryngology -Head and Neck Surgery, and on Cochrane reviews. Hoarseness can be caused by acute (42.1%) and chronic laryngitis (9.7%), functional vocal disturbances (30%), and benign (10.7-31%) and malignant tumors (2.2-3%), as well as by neurogenic disturbances such as vocal cord paresis (2.8-8%), physiologic aging of the voice (2%), and psychogenic factors (2-2.2 %). Hoarseness is very rarely a manifestation of internal medical illness. The treatment of hoarseness has been studied in only a few randomized controlled trials, all of which were on a small scale. Voice therapy is often successful in the treatment of functional and organic vocal disturbances (level 1a evidence). Surgery on the vocal cords is indicated to treat tumors and inadequate vocal cord closure. The only entity causing hoarseness that can be treated pharmacologically is chronic laryngitis associated with gastro-esophageal reflux, which responds to treatment of the reflux disorder. The empirical treatment of hoarseness with antibiotics or corticosteroids is not recommended. Voice therapy, vocal cord surgery, and drug therapy for appropriate groups of patients with hoarseness are well documented as effective by the available evidence. In patients with risk factors, especially smokers, hoarseness should be immediately evaluated by laryngos - copy.
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