Antibiotics for the common cold and acute purulent rhinitis

Abstract

BACKGROUND: It has long been believed that antibiotics have no role in the treatment of common colds yet they are often prescribed in the belief that they may prevent secondary bacterial infections. OBJECTIVES: To determine: 1. the efficacy of antibiotics, in comparison to placebo; 2. if antibiotics have any influence on acute purulent rhinitis; and 3. the adverse outcomes for antibiotics in this condition. SEARCH STRATEGY: For this 2009 update we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 3), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1966 to July 2009) and EMBASE (1980 to August 2009). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing any antibiotic therapy against placebo in people with symptoms of acute upper respiratory tract infections for less than seven days, or acute purulent rhinitis less than 10 days in duration. DATA COLLECTION AND ANALYSIS: Both review authors independently assessed trial quality and extracted data. MAIN RESULTS: Participants receiving antibiotics did no better in terms of lack of cure or persistence of symptoms than those on placebo (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.59 to 1.51, (random-effects)), based on a pooled analysis of six trials with a total of 1047 participants. The RR of adverse effects in the antibiotic group was 1.8, 95% CI 1.01 to 3.21, (random-effects). Adult participants had a significantly greater risk of adverse effects with antibiotics than with placebo (RR 2.62, 95% CI 1.32 to 5.18) (random-effects) while there was no greater risk in children (RR 0.91, 95% CI 0.51 to 1.63). The pooled RR for persisting acute purulent rhinitis with antibiotics compared to placebo was 0.63 (95% CI 0.38 to 1.07) (random-effects), based on five studies with 772 participants. There was an increase in adverse effects in the studies of antibiotic for acute purulent rhinitis (RR 1.46, 95% CI 1.10 to 1.94). AUTHORS' CONCLUSIONS: There is insufficient evidence of benefit to warrant the use of antibiotics for upper respiratory tract infections in children or adults. Antibiotics cause significant adverse effects in adults when given for the common cold and in all ages when given for acute purulent rhinitis. The evidence on acute purulent rhinitis and acute clear rhinitis suggests no benefit for antibiotics for these conditions and their routine use is not recommended. ANTIBIOTICS FOR THE COMMON COLD, AN INFECTION OF THE UPPER RESPIRATORY TRACT: Colds are usually caused by viruses, which do not respond to antibiotics. Furthermore, antibiotics cause adverse effects, especially diarrhoea, and overuse can increase levels of antibiotic resistance in the community. Our results do not show any benefit from taking antibiotics for the common cold and adverse gastrointestinal effects are common. A runny nose with coloured discharge (acute purulent rhinitis) is associated with the common cold. Results suggest that antibiotics do not improve this aspect and antibiotics are not recommended as an initial treatment for this condition as most people get better without them.