Antibióticos para la bronquitis aguda
Referencias
References to studies included in this review
References to studies excluded from this review
Additional references
References to other published versions of this review
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Ir a:
| Methods | Double‐blinded RCT | |
| Participants | 52 adults (aged 18 to 65), with 2 weeks or less of lower respiratory infection with sputum production and no evidence of pneumonia clinically or radiographically. Dropouts = 2/52 | |
| Interventions | Enteric‐coated erythromycin 333 mg 3 times a day for 7 days versus placebo. Volunteers kept daily logs of multiple symptoms and were re‐examined on day 8. | |
| Outcomes | Cough, sputum, fever, rhinorrhoea, chest discomfort, earache, sore throat, work disability, feeling ill, and nausea daily; and clinical impression at follow‐up | |
| Notes | 29 participants had sputum cultured (27 = normal flora, 1 = Haemophilus influenzae, 1 = Streptococcus pneumoniae), outcomes not reported; 17/23 had more than 5 white blood cells on Gram stain. Fewer than 30% of eligible patients opted to volunteer (most wanted antibiotics). | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Low risk | |
| Methods | Double‐blinded RCT | |
| Participants | 63 adults (age 18 years or older) with productive cough (mean duration = 7 days) and no clinical evidence of sinusitis or pneumonia. Dropouts = 15 (6 no follow‐up; 9 stopped taking pills during trial, authors state that there was no difference in results with or without the partial data from the latter 9) | |
| Interventions | Enteric‐coated erythromycin base, 333 mg 3 times a day for 10 days, versus placebo. Participants kept daily logs of 5 symptoms and had follow‐up visit at approximately day 14. | |
| Outcomes | Day cough, night cough, sputum production, congestion, sore throat, feeling poorly, activity limitation, and use of cough/cold medications daily; and cough, sputum, and abnormal lung examination at follow‐up | |
| Notes | Only 20% of eligible patients enrolled in study (but unenrolled not different clinically per chart review). 13 erythromycin participants dropped out due to gastrointestinal side effects. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Low risk | |
| Methods | Double‐blinded RCT | |
| Participants | 220 adults (aged 18 to 88 years) with cough (with or without sputum) of 2 to 14 days duration | |
| Interventions | Azithromycin 500 mg on day 1 and 250 mg daily on days 2 to 5 versus vitamin C 500 mg on day 1 and 250 mg daily on days 2 to 5 (total dose 1.5 g) | |
| Outcomes | Acute bronchitis health‐related quality of life on days 3 and 7, proportion of participants who had returned to usual daily activities on days 3 and 7, side effects on days 3 and 7 | |
| Notes | 88% of eligible population included. Both groups received cough suppressant (dextromethorphan) and albuterol inhaler. No difference between groups in the use of albuterol inhaler at follow‐up. 31/220 (14%) lost to follow‐up. Timing of outcome at day 3 and day 7 (day 7 taken as outcome time in this review). Study was stopped by data‐monitoring and safety committee because "outcomes were equivalent and there was sufficient precision to be confident that the likelihood of detecting a clinically meaningful difference with a larger sample was so small that continued enrolment of patients would be inappropriate". | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Low risk | |
| Methods | Double‐blinded RCT | |
| Participants | 67 people aged 14 years or older with fewer than 15 days of productive cough (in the absence of clinical pneumonitis). Excluded if could not produce sputum specimen for Gram stain. Dropouts = 13/67 | |
| Interventions | Trimethoprim‐sulfamethoxazole (160/800) twice daily for 7 days versus identical‐appearing placebo. Participants kept daily symptom logs. No follow‐up visit | |
| Outcomes | Cough, night cough, sputum production, general well‐being, fever, work disability, use of adjunctive medications, and side effects | |
| Notes | No mention of per cent of eligible patients who refused enrolment | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Low risk | |
| Methods | Double‐blinded RCT | |
| Participants | 164 people with a productive cough in conjunction with a cold or influenza‐like illness that had not resolved after 2 days | |
| Interventions | Self treatment with demethyl chlortetracycline (300 mg) or placebo twice daily for 5 days. Participants kept daily symptom logs. No initial or follow‐up visits | |
| Outcomes | Duration of and presence on day 5 of cough, productive cough, and purulent sputum; and duration of time off work | |
| Notes | These were unpublished data about a subgroup of patients with a cold or influenza‐like illness; total number of people who treated themselves for a single episode of illness and returned symptom cards = 301. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Low risk | |
| Methods | Double‐blinded RCT | |
| Participants | 23 adults (aged 18 to 65 years) with productive cough of fewer than 30 days duration and no clinical evidence of pneumonia. Dropouts = 0 | |
| Interventions | Erythromycin (250 mg) 4 times a day for 10 days versus identical‐looking placebo. Participants kept daily symptom log and were re‐examined on day 7 or 8. | |
| Outcomes | Cough, night cough, ability to perform normal work, and general well‐being daily and at follow‐up; overall use of over‐the‐counter medications and side effects; and abnormal lung exam at follow‐up | |
| Notes | This was part of a 2 x 2 designed study comparing erythromycin + albuterol inhaler versus erythromycin + placebo versus albuterol inhaler + placebo versus placebo + placebo. The data extracted for this review were unpublished and limited to the erythromycin + placebo group versus the placebo + placebo group. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Unclear risk | Not reported |
| Methods | Double‐blinded RCT | |
| Participants | 75 people (aged 16 to 64 years) with common cold and concomitant non‐purulent tracheobronchitis and no evidence of sinusitis, pharyngitis, purulent bronchitis, or pneumonia. Mean duration of illness 3 days | |
| Interventions | Amoxicillin‐clavulanic acid (375 mg 3 times a day for 5 days) versus identical‐looking placebo. Participants re‐evaluated on days 5 to 7. | |
| Outcomes | Persistent or worse symptoms versus cure at follow‐up | |
| Notes | These were unpublished data about a subgroup of patients in a study of people with common cold; total number of participants in study was 307. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Incomplete outcome data (attrition bias) | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Low risk | |
| Methods | Double‐blinded RCT | |
| Participants | 91 people (age 8 years or older) with cough and sputum for up to 2 weeks, and no signs of sinusitis, otitis, or pneumonia and no localised abnormal lung exam. All tested for Mycoplasma (one‐half with negative serology excluded). | |
| Interventions | Erythromycin (250 mg 4 times a day for 10 days) versus identical‐looking placebo. Participants kept daily logs and returned for follow‐up visit at days 14 to 18. | |
| Outcomes | Cough, chest congestion, use of cough medication, general well‐being, sleep, and normal activities | |
| Notes | No mention of eligible patients who refused to volunteer | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Incomplete outcome data (attrition bias) | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | High risk | |
| Methods | RCT | |
| Participants | 426, subgroup of 807 patients with acute uncomplicated lower respiratory tract infection. Inclusion criteria: aged 3 years or older with uncomplicated LRTI for fewer than 21 days with cough as main symptom and at least 1 of sputum, chest pain, dyspnoea, and wheeze | |
| Interventions | 6‐arm RCT: (1) no leaflet or antibiotics; (2) immediate antibiotics plus leaflet; (3) immediate antibiotics and no leaflet; (4) leaflet only; (5) leaflet and delayed antibiotics; (6) no leaflet and delayed antibiotics. Only data from the no‐treatment and immediate‐antibiotic groups included in the analysis. The antibiotic used was amoxicillin 250 mg 3 times a day for 10 days (125 mg if younger than 10 years) or erythromycin 250 mg 4 times a day if penicillin allergic. | |
| Outcomes | Daily diary for 3 weeks recording antipyretic use and 6 symptoms (cough, dyspnoea, sputum production, well‐being, sleep disturbance, and activity disturbance); satisfaction questionnaire; belief in antibiotics scale; reported antibiotic use; note review for reconsultation | |
| Notes | 25% of participants lost to follow‐up in no‐treatment and immediate‐antibiotic arms | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | High risk | Open design |
| Blinding (performance bias and detection bias) | High risk | |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Low risk | |
| Methods | RCT | |
| Participants | 2061 people aged 18 years or older presenting with lower respiratory tract infection with cough duration fewer than 28 days | |
| Interventions | Amoxicillin 1 g 3 times daily for 7 days | |
| Outcomes | Duration of symptoms rated as moderately bad or worsening; mean symptom severity on days 2 to 4; proportion with symptoms resolved on day 7; new or worsening symptoms presenting clinically to general practitioners; and adverse effects | |
| Notes | Adequately powered for subgroup analysis of participants aged over 60 (n = 595) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | Clinicians, participants, and outcome assessors all blinded. |
| Blinding (performance bias and detection bias) | Low risk | |
| Incomplete outcome data (attrition bias) | Low risk | 88% follow‐up in both intervention and control groups |
| Selective reporting (reporting bias) | Low risk | |
| Other bias | Low risk | |
| Methods | RCT (3 arms) | |
| Participants | 420 people age 18 to 70 years presenting with respiratory tract infection of 1‐week evolution with cough as the predominant symptom. We included data from the antibiotic arm (137 participants) and the placebo arm (143 participants). | |
| Interventions | Ibuprofen or amoxicillin‐clavulanic acid (dose 500 mg/125 mg) | |
| Outcomes | Number days with frequent cough defined using a symptom diary. Secondary outcomes included clinically improved or cured, time to symptom resolution, median days with cough, and adverse effects. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Participants were randomised using a random number table into 3 blocks. |
| Allocation concealment (selection bias) | Low risk | Participants were unaware of allocation. Clinicians gave participants sealed containers, so they were also unaware of allocation. |
| Blinding (performance bias and detection bias) | Low risk | Participants blinded and described as single‐blind study. Tablets placed in sealed containers before dispatch by an independent pharmacist. |
| Blinding (performance bias and detection bias) | Low risk | Outcomes collected in symptom diaries not seen by the investigators. |
| Incomplete outcome data (attrition bias) | Low risk | > 90% follow‐up |
| Selective reporting (reporting bias) | Low risk | Protocol available |
| Other bias | Unclear risk | Not reported |
| Methods | Double‐blinded RCT | |
| Participants | 294, a subgroup of 676 participants, mean age 39 (range 18 to 79) with acute bronchitis. Inclusion criteria: aged 18 years or older, symptoms of recent onset within last 5 days, nightly cough as main symptom (without at least 4 awakenings during the night) and without reduced FEV1 (more than 75% normal) | |
| Interventions | 4‐arm RCT: (1) Myrtol standardised (phytotherapeutic extract); (2) cefuroxime 500 mg twice daily; (3) ambroxol (mucolytic agent); (4) placebo capsules. Only data from cefuroxime and placebo arms were included in the analysis. | |
| Outcomes | Daytime cough, nighttime cough, type of cough, and general well‐being recorded by each participant; clinical examination at follow‐up; "overall efficacy" judged by physician and participant; bronchial hyperreactivity; change in lung function; number of participants with relapse within 4 weeks; side effects. Physician assessment at days 7 and 14; diary data on 3 follow‐up time periods: day 7, 14, 15 to 28 | |
| Notes | Secretolytics, mucolytics, and antitussives prohibited during the study. Multiple hypothesis testing for all 4 treatment groups. 3/343 (0.9%) lost to follow‐up | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Low risk | |
| Methods | Triple‐blind, placebo‐controlled RCT | |
| Participants | 660 participants, mean age 31; 55% female. Productive cough for < 2 weeks, no serious medical comorbidity, and no antibiotic treatment in previous 2 weeks. All participants had HIV test and chest X‐ray at baseline. Excluded if chest X‐ray showed pneumonia or tuberculosis | |
| Interventions | Amoxicillin 500 mg 3 times a day for 7 days versus identical placebo tablet | |
| Outcomes | Clinical cure at 14 days as measured by > 75% reduction in Acute Bronchitis Severity Score | |
| Notes | Reported as first study of acute bronchitis treatment that used an equivalence design. Data available for HIV‐positive patients but not included in the review. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Participants were randomised independently using a random number generator. |
| Allocation concealment (selection bias) | Low risk | Antibiotic or placebo tablets identical in appearance, taste, and smell were placed in identical sealed, opaque containers identifiable only with a unique study identifier. |
| Blinding (performance bias and detection bias) | Low risk | All clinical and research staff were blinded to the allocation of participants, and the allocation schedule was kept in the office of the Chief Research Pharmacist in the host institution. |
| Blinding (performance bias and detection bias) | Low risk | |
| Incomplete outcome data (attrition bias) | Low risk | > 85% follow‐up for outcome data |
| Selective reporting (reporting bias) | Unclear risk | No access to original protocol, though selective reporting not apparent from trial description. |
| Other bias | Low risk | |
| Methods | Double‐blinded RCT | |
| Participants | 39 people (older than 12 years) with chief complaint of cough with purulent sputum and without the following: other known bacterial infection, flu‐like syndrome, chief complaint of coryza or sore throat with minimal sputum, or chest radiograph consistent with pneumonia (not all had radiographs). Dropouts = 8/31 | |
| Interventions | Doxycycline (100 mg twice daily on day 1 and 100 mg 4 times a day on days 2 to 7) versus placebo. Kept daily symptom log and had follow‐up visit at day 14 | |
| Outcomes | Cough, sputum, feverishness, days missed from work or normal activity, chest pain, dyspnoea, side effects | |
| Notes | No mention of eligible patients who refused to volunteer | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Incomplete outcome data (attrition bias) | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Low risk | |
| Methods | Double‐blinded RCT | |
| Participants | 212 people aged > 14 years with cough and purulent sputum for up to 1 week. Excluded if chest exam was abnormal. Dropouts = 5/212 | |
| Interventions | Participants given doxycycline or placebo (2 pills on day 1, then 1 daily for 9 days). Had follow‐up after 1 week; if "satisfied with outcome", then treatment ended; if not, then completed remaining pills and continued to record symptoms. Participants completed daily symptom logs. | |
| Outcomes | Day cough, night cough, "yellow spit", "clear spit", "off color", runny nose, sore throat, general aches, headache, vomiting, off work daily and at follow‐up; clinical impression at follow‐up; and illnesses over next 6 months | |
| Notes | No difference in average pill consumption between groups (9.3 in doxycycline group versus 9.2 in placebo group). No mention of eligible patients who refused to volunteer | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Unclear risk | Not reported |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Low risk | |
| Methods | Double‐blinded RCT | |
| Participants | 158 adults (age 18 years or older) with cough and purulent sputum, and no clinical sinusitis or pneumonia. Dropouts = 13/158 | |
| Interventions | Doxycycline (200 mg on day 1 and 100 mg on days 2 to 10) versus placebo. Participants kept daily symptom log, and had follow‐up visit on day 11. | |
| Outcomes | Day cough, night cough, productive cough, feeling ill, impairment of activities, and side effects daily; and clinical impression and auscultatory abnormalities at follow‐up | |
| Notes | 158/209 eligible patients entered study (no difference in age, sex, or main symptoms between participants and unenrolled). | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Low risk | |
| Methods | Double‐blinded RCT | |
| Participants | 74 adults (age 21 to 65 years) with cough and sputum, and concurrent upper respiratory tract infection, rhonchi, or history of fever; excluded if temperature more than 39.5° C, signs or symptoms of sinus infection, or chest radiograph with consolidation (but not ordered on all). Dropouts = 5/74 | |
| Interventions | Doxycycline (100 mg twice daily on day 1, then 100 mg 4 times a day on days 2 to 7) versus identical‐looking placebo. Kept daily symptom log, returned for follow‐up visit on day 7 to 10. If not improved at follow‐up, could obtain antibiotic prescription. | |
| Outcomes | General well‐being, bother of cough, night cough, activity limitation, feverishness, sputum colour daily, doses of antitussives, and clinical impression at follow‐up | |
| Notes | No mention of eligible patients who refused to volunteer | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | |
| Allocation concealment (selection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Blinding (performance bias and detection bias) | Low risk | |
| Incomplete outcome data (attrition bias) | Low risk | |
| Selective reporting (reporting bias) | Unclear risk | Not reported |
| Other bias | Unclear risk | Not reported |
FEV1: forced expiratory volume in one second
LRTI: lower respiratory tract infection
RCT: randomised controlled trial
Characteristics of excluded studies [ordered by study ID]
Ir a:
| Study | Reason for exclusion |
| 185 participants with acute respiratory tract infection from 2 health centres in Jordan. Assignment to antibiotic (azithromycin) was by means of alternation, not randomisation. At follow‐up of 3 days, 1 week, and 2 weeks, participants administered azithromycin or placebo did similarly in terms of the proportions improved or cured and duration of illness. The authors of the study concluded that routine use of antibiotics (azithromycin) in acute respiratory tract infection is unlikely to alter the course of the illness. | |
| Randomised controlled trial concerned with application of a diagnostic test (serum calcitonin precursor, procalcitonin) that is raised in bacterial infections. 243 people admitted to hospital with suspected lower respiratory tract infections were randomly assigned to standard care (n = 119) or procalcitonin‐guided treatment (n = 124). On the basis of serum procalcitonin concentrations, use of antibiotics was more or less discouraged (< 0.1 µg/L or < 0.25 µg/L) or encouraged (≥ 0.5 µg/L or ≥ 0.25 µg/L), respectively. Re‐evaluation was possible after 6 to 24 hours in both groups. Primary endpoint was use of antibiotics. 59 (24%) participants had diagnosis of "acute bronchitis". Antibiotic use decreased in the procalcitonin group. Withholding antibiotic treatment based on procalcitonin measurement did not compromise patient outcome. | |
| Randomised controlled trial of "delayed" versus "immediate" antibiotics for acute cough. Participants randomised to "delayed" arm were asked to wait a week before collecting their prescription. 55% of participants did not pick up their prescription. More participants were satisfied and "enabled" in the immediate‐treatment arm. | |
| Participants were children with "symptoms referable to the respiratory tract", therefore likely many had upper respiratory infections (78% to 96% had runny nose, 74% to 83% had inflamed nasal mucosa). | |
| Post‐randomisation exclusion of 23% of the sample due to laboratory evidence of pertussis infection. Outcomes not clearly reported. | |
| Participants were adults with upper respiratory infection. Not all had cough, and no information available on the subgroup of patients with productive cough. | |
| Explicit data from the study were not published and the data are no longer available. |
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with cough Show forest plot | 4 | 275 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.64 [0.49, 0.85] |
| Analysis 1.1  Comparison 1 Cough at follow‐up visit, Outcome 1 Number of participants with cough. | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with night cough Show forest plot | 4 | 538 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.54, 0.83] |
| Analysis 2.1  Comparison 2 Night cough at follow‐up visit, Outcome 1 Number of participants with night cough. | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with productive cough Show forest plot | 7 | 713 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.82, 1.16] |
| Analysis 3.1  Comparison 3 Productive cough at follow‐up visit, Outcome 1 Number of participants with productive cough. | ||||
| 1.1 Acute bronchitis studies | 6 | 549 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.72, 1.08] |
| 1.2 Subgroup with productive cough from URTI study | 1 | 164 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.24 [0.88, 1.75] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mean number of days of cough Show forest plot | 7 | 2776 | Mean Difference (IV, Fixed, 95% CI) | ‐0.46 [‐0.87, ‐0.04] |
| Analysis 4.1  Comparison 4 Days of cough, Outcome 1 Mean number of days of cough. | ||||
| 1.1 Acute bronchitis studies | 6 | 2350 | Mean Difference (IV, Fixed, 95% CI) | ‐0.55 [1.00, ‐0.10] |
| 1.2 Subgroup with no placebo control | 1 | 426 | Mean Difference (IV, Fixed, 95% CI) | 0.11 [‐1.01, 1.23] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mean number of days of productive cough Show forest plot | 6 | 699 | Mean Difference (IV, Fixed, 95% CI) | ‐0.43 [‐0.93, 0.07] |
| Analysis 5.1  Comparison 5 Days of productive cough, Outcome 1 Mean number of days of productive cough. | ||||
| 1.1 Acute bronchitis studies | 5 | 535 | Mean Difference (IV, Fixed, 95% CI) | ‐0.52 [‐1.03, ‐0.01] |
| 1.2 Subgroup with productive cough from URTI study | 1 | 164 | Mean Difference (IV, Fixed, 95% CI) | 1.04 [‐1.04, 3.12] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants reporting no activity limitations or described as cured/globally improved Show forest plot | 11 | 3841 | Risk Ratio (M‐H, Random, 95% CI) | 1.07 [0.99, 1.15] |
| Analysis 6.1  Comparison 6 Clinically improved, Outcome 1 Number of participants reporting no activity limitations or described as cured/globally improved. | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with limitations Show forest plot | 5 | 478 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.46, 1.22] |
| Analysis 7.1  Comparison 7 Limitation in work or activities at follow‐up visit, Outcome 1 Number of participants with limitations. | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mean number of days of feeling ill Show forest plot | 5 | 809 | Mean Difference (IV, Fixed, 95% CI) | ‐0.64 [‐1.16, ‐0.13] |
| Analysis 8.1  Comparison 8 Days of feeling ill, Outcome 1 Mean number of days of feeling ill. | ||||
| 1.1 Acute bronchitis studies | 4 | 435 | Mean Difference (IV, Fixed, 95% CI) | ‐0.58 [‐1.16, ‐0.00] |
| 1.2 Subgroup with no placebo control | 1 | 374 | Mean Difference (IV, Fixed, 95% CI) | ‐0.86 [‐1.97, 0.25] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mean number of days of impaired activities Show forest plot | 6 | 767 | Mean Difference (IV, Fixed, 95% CI) | ‐0.49 [‐0.94, ‐0.04] |
| Analysis 9.1  Comparison 9 Days of impaired activities, Outcome 1 Mean number of days of impaired activities. | ||||
| 1.1 Acute bronchitis studies | 5 | 393 | Mean Difference (IV, Fixed, 95% CI) | ‐0.48 [‐0.96, 0.01] |
| 1.2 Subgroup with no placebo control | 1 | 374 | Mean Difference (IV, Fixed, 95% CI) | ‐0.57 [‐1.75, 0.61] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants not improved Show forest plot | 6 | 891 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.48, 0.79] |
| Analysis 10.1  Comparison 10 Not improved by physician's global assessment at follow‐up visit, Outcome 1 Number of participants not improved. | ||||
| 1.1 Acute bronchitis studies | 5 | 816 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.44 [0.30, 0.65] |
| 1.2 Subgroup with non‐purulent tracheobronchitis from URTI study | 1 | 75 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.03 [0.82, 1.29] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with abnormal lung exams Show forest plot | 5 | 613 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.54 [0.41, 0.70] |
| Analysis 11.1  Comparison 11 Abnormal lung exam at follow‐up visit, Outcome 1 Number of participants with abnormal lung exams. | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with adverse effects Show forest plot | 12 | 3496 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.20 [1.05, 1.36] |
| Analysis 12.1  Comparison 12 Adverse effects, Outcome 1 Number of participants with adverse effects. | ||||
| 1.1 Acute bronchitis studies | 11 | 3162 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [1.07, 1.40] |
| 1.2 Subgroup with no placebo control | 1 | 334 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.61, 1.50] |
'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study.
'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Forest plot of comparison: Cough at follow‐up visit, outcome: number of participants with cough.
Forest plot of comparison: 8 Days of cough, outcome: mean number of days of cough.
Forest plot of comparison: Clinically improved, outcome: number of participants reporting no limitations or described as cured/well/symptoms resolved or globally improved.
Forest plot of comparison: Days of feeling ill, outcome: mean number of days of feeling ill.
Forest plot of comparison: Not improved by physician's global assessment at follow‐up visit, outcome: number of participants not improved.
Forest plot of comparison: Number of participants with adverse effects.
Comparison 1 Cough at follow‐up visit, Outcome 1 Number of participants with cough.
Comparison 2 Night cough at follow‐up visit, Outcome 1 Number of participants with night cough.
Comparison 3 Productive cough at follow‐up visit, Outcome 1 Number of participants with productive cough.
Comparison 4 Days of cough, Outcome 1 Mean number of days of cough.
Comparison 5 Days of productive cough, Outcome 1 Mean number of days of productive cough.
Comparison 6 Clinically improved, Outcome 1 Number of participants reporting no activity limitations or described as cured/globally improved.
Comparison 7 Limitation in work or activities at follow‐up visit, Outcome 1 Number of participants with limitations.
Comparison 8 Days of feeling ill, Outcome 1 Mean number of days of feeling ill.
Comparison 9 Days of impaired activities, Outcome 1 Mean number of days of impaired activities.
Comparison 10 Not improved by physician's global assessment at follow‐up visit, Outcome 1 Number of participants not improved.
Comparison 11 Abnormal lung exam at follow‐up visit, Outcome 1 Number of participants with abnormal lung exams.
Comparison 12 Adverse effects, Outcome 1 Number of participants with adverse effects.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with cough Show forest plot | 4 | 275 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.64 [0.49, 0.85] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with night cough Show forest plot | 4 | 538 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.67 [0.54, 0.83] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with productive cough Show forest plot | 7 | 713 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.97 [0.82, 1.16] |
| 1.1 Acute bronchitis studies | 6 | 549 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.72, 1.08] |
| 1.2 Subgroup with productive cough from URTI study | 1 | 164 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.24 [0.88, 1.75] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mean number of days of cough Show forest plot | 7 | 2776 | Mean Difference (IV, Fixed, 95% CI) | ‐0.46 [‐0.87, ‐0.04] |
| 1.1 Acute bronchitis studies | 6 | 2350 | Mean Difference (IV, Fixed, 95% CI) | ‐0.55 [1.00, ‐0.10] |
| 1.2 Subgroup with no placebo control | 1 | 426 | Mean Difference (IV, Fixed, 95% CI) | 0.11 [‐1.01, 1.23] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mean number of days of productive cough Show forest plot | 6 | 699 | Mean Difference (IV, Fixed, 95% CI) | ‐0.43 [‐0.93, 0.07] |
| 1.1 Acute bronchitis studies | 5 | 535 | Mean Difference (IV, Fixed, 95% CI) | ‐0.52 [‐1.03, ‐0.01] |
| 1.2 Subgroup with productive cough from URTI study | 1 | 164 | Mean Difference (IV, Fixed, 95% CI) | 1.04 [‐1.04, 3.12] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants reporting no activity limitations or described as cured/globally improved Show forest plot | 11 | 3841 | Risk Ratio (M‐H, Random, 95% CI) | 1.07 [0.99, 1.15] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with limitations Show forest plot | 5 | 478 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.46, 1.22] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mean number of days of feeling ill Show forest plot | 5 | 809 | Mean Difference (IV, Fixed, 95% CI) | ‐0.64 [‐1.16, ‐0.13] |
| 1.1 Acute bronchitis studies | 4 | 435 | Mean Difference (IV, Fixed, 95% CI) | ‐0.58 [‐1.16, ‐0.00] |
| 1.2 Subgroup with no placebo control | 1 | 374 | Mean Difference (IV, Fixed, 95% CI) | ‐0.86 [‐1.97, 0.25] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mean number of days of impaired activities Show forest plot | 6 | 767 | Mean Difference (IV, Fixed, 95% CI) | ‐0.49 [‐0.94, ‐0.04] |
| 1.1 Acute bronchitis studies | 5 | 393 | Mean Difference (IV, Fixed, 95% CI) | ‐0.48 [‐0.96, 0.01] |
| 1.2 Subgroup with no placebo control | 1 | 374 | Mean Difference (IV, Fixed, 95% CI) | ‐0.57 [‐1.75, 0.61] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants not improved Show forest plot | 6 | 891 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.48, 0.79] |
| 1.1 Acute bronchitis studies | 5 | 816 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.44 [0.30, 0.65] |
| 1.2 Subgroup with non‐purulent tracheobronchitis from URTI study | 1 | 75 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.03 [0.82, 1.29] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with abnormal lung exams Show forest plot | 5 | 613 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.54 [0.41, 0.70] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with adverse effects Show forest plot | 12 | 3496 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.20 [1.05, 1.36] |
| 1.1 Acute bronchitis studies | 11 | 3162 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.22 [1.07, 1.40] |
| 1.2 Subgroup with no placebo control | 1 | 334 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.95 [0.61, 1.50] |
