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

Christina Chang, Allen Cheng, Anne Chang

    Research output: Contribution to journalArticleResearchpeer-review

    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.
    Original languageEnglish
    Article numberCD006088
    Pages (from-to)1-35
    Number of pages35
    JournalCochrane Database of Systematic Reviews
    Volume2012
    Issue number2
    DOIs
    Publication statusPublished - 15 Feb 2012

    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{4ca05c6af47a440282fafda27b54aa03,
    title = "Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults (Review)",
    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.",
    author = "Christina Chang and Allen Cheng and Anne Chang",
    note = "NHMRC Grant No. 545216",
    year = "2012",
    month = "2",
    day = "15",
    doi = "10.1002/14651858.CD006088.pub3",
    language = "English",
    volume = "2012",
    pages = "1--35",
    journal = "Cochrane database of systematic reviews (Online)",
    issn = "1469-493X",
    publisher = "John Wiley & Sons",
    number = "2",

    }

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

    In: Cochrane Database of Systematic Reviews, Vol. 2012, No. 2, CD006088, 15.02.2012, p. 1-35.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults (Review)

    AU - Chang, Christina

    AU - Cheng, Allen

    AU - Chang, Anne

    N1 - NHMRC Grant No. 545216

    PY - 2012/2/15

    Y1 - 2012/2/15

    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 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.

    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 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.

    U2 - 10.1002/14651858.CD006088.pub3

    DO - 10.1002/14651858.CD006088.pub3

    M3 - Article

    VL - 2012

    SP - 1

    EP - 35

    JO - Cochrane database of systematic reviews (Online)

    JF - Cochrane database of systematic reviews (Online)

    SN - 1469-493X

    IS - 2

    M1 - CD006088

    ER -