Antibiotics for pediatric chronic wet cough: Cochrane review

  • Marchant JM & al.
  • Cochrane Database Syst Rev
  • 31 Jul 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • This update supports antibiotics to treat undifferentiated, wet pediatric chronic cough.
  • Adverse events and long-term outcomes are unclear.

Why this matters

  • Chronic wet cough:
    • Is thought to potentially evolve into bronchiectasis if untreated;
    • Is most often because of protracted bacterial bronchitis in children.
  • Antibiotics are recommended, although treatment duration varies among guidelines.

Key results

  • Bias risk ranged from low to high.
  • Children’s ages: 21 months to 6 years.
  • Cough durations: up to 15 weeks.
  • Treatment duration: 7-14 days.
  • Antibiotics: amoxicillin/clavulanate acid (2 studies), erythromycin (1 study).
  • Intention-to-treat analysis linked treatment to fewer uncured children at follow-up: 
    • OR: 0.15 (95% CI, 0.07-0.31; 3 trials);
    • Number needed to treat for benefit (NNTB): 3; 
    • Moderate-quality evidence.
  • Need for further antibiotics later: 
    • OR: 0.10 (95% CI, 0.03-0.34; 2 trials);
    • NNTB: 4;
    • Moderate-quality evidence.
  • Adverse events: 
    • OR: 1.88 (95% CI, 0.62-5.69; 3 trials);
    • Low-quality evidence.

Study design

  • Meta-analysis of 3 randomized controlled trials, including 1 new trial since last review (n=190).
  • Trials compared antibiotics vs placebo or control group in children with undifferentiated wet cough lasting >10 days.
  • Funding: National Institute for Health Research (United Kingdom).

Limitations

  • No long-term outcomes.
  • Variable definitions of “chronic” cough.
  • Ideal treatment duration remains unclear.

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