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

C. C. Chang, A. C. Cheng, A. B. Chang

    Research output: Contribution to journalReview articleResearchpeer-review

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    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 2009, Issue 2) which contains the Acute Respiratory Infections Group's Specialised Register; MEDLINE (January 1966 to July 2009); OLDMEDLINE (1950 to 1965); and EMBASE (1980 to July 2009).

    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. Data were extracted from these studies, assessed for methodological quality without disagreement, and analysed using standard methods.

    Main results: Four studies were included with a total of 224 participants; 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) 0.36, 95% confidence interval (CI) 0.16 to 0.77; number needed to treat (NNT) 5, 95% CI 3 to 16 for children and OR 0.32, 95% CI 0.13 to 0.75; NNT 5, 95% CI 3 to 19 for adults). 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; NNT 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.

    Original languageEnglish
    Pages (from-to)1-28
    Number of pages28
    JournalCochrane Database of Systematic Reviews
    Volume17
    Issue number4
    DOIs
    Publication statusPublished - Oct 2007

    Fingerprint

    Cough
    Pneumonia
    Expectorants
    Anti-Bacterial Agents
    Confidence Intervals
    Numbers Needed To Treat
    Odds Ratio
    Antitussive Agents
    Bromhexine
    Ambroxol
    Codeine
    Histamine Antagonists
    MEDLINE
    Respiratory Tract Infections
    Patient Selection
    Libraries
    Randomized Controlled Trials
    Placebos

    Cite this

    @article{49ae1c889d5b468883f1f42a6695dc08,
    title = "Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults",
    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 2009, Issue 2) which contains the Acute Respiratory Infections Group's Specialised Register; MEDLINE (January 1966 to July 2009); OLDMEDLINE (1950 to 1965); and EMBASE (1980 to July 2009).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. Data were extracted from these studies, assessed for methodological quality without disagreement, and analysed using standard methods.Main results: Four studies were included with a total of 224 participants; 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) 0.36, 95{\%} confidence interval (CI) 0.16 to 0.77; number needed to treat (NNT) 5, 95{\%} CI 3 to 16 for children and OR 0.32, 95{\%} CI 0.13 to 0.75; NNT 5, 95{\%} CI 3 to 19 for adults). 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; NNT 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.",
    author = "Chang, {C. C.} and Cheng, {A. C.} and Chang, {A. B.}",
    year = "2007",
    month = "10",
    doi = "10.1002/14651858.CD006088.pub2",
    language = "English",
    volume = "17",
    pages = "1--28",
    journal = "Cochrane database of systematic reviews (Online)",
    issn = "1469-493X",
    publisher = "John Wiley & Sons",
    number = "4",

    }

    Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. / Chang, C. C.; Cheng, A. C.; Chang, A. B.

    In: Cochrane Database of Systematic Reviews, Vol. 17, No. 4, 10.2007, p. 1-28.

    Research output: Contribution to journalReview articleResearchpeer-review

    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, C. C.

    AU - Cheng, A. C.

    AU - Chang, A. B.

    PY - 2007/10

    Y1 - 2007/10

    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 the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 2) which contains the Acute Respiratory Infections Group's Specialised Register; MEDLINE (January 1966 to July 2009); OLDMEDLINE (1950 to 1965); and EMBASE (1980 to July 2009).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. Data were extracted from these studies, assessed for methodological quality without disagreement, and analysed using standard methods.Main results: Four studies were included with a total of 224 participants; 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) 0.36, 95% confidence interval (CI) 0.16 to 0.77; number needed to treat (NNT) 5, 95% CI 3 to 16 for children and OR 0.32, 95% CI 0.13 to 0.75; NNT 5, 95% CI 3 to 19 for adults). 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; NNT 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.

    AB - 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 2009, Issue 2) which contains the Acute Respiratory Infections Group's Specialised Register; MEDLINE (January 1966 to July 2009); OLDMEDLINE (1950 to 1965); and EMBASE (1980 to July 2009).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. Data were extracted from these studies, assessed for methodological quality without disagreement, and analysed using standard methods.Main results: Four studies were included with a total of 224 participants; 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) 0.36, 95% confidence interval (CI) 0.16 to 0.77; number needed to treat (NNT) 5, 95% CI 3 to 16 for children and OR 0.32, 95% CI 0.13 to 0.75; NNT 5, 95% CI 3 to 19 for adults). 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; NNT 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.

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    U2 - 10.1002/14651858.CD006088.pub2

    DO - 10.1002/14651858.CD006088.pub2

    M3 - Review article

    VL - 17

    SP - 1

    EP - 28

    JO - Cochrane database of systematic reviews (Online)

    JF - Cochrane database of systematic reviews (Online)

    SN - 1469-493X

    IS - 4

    ER -