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.
PICO
Plain language summary
Over‐the‐counter medications to help reduce cough for children and adults on antibiotics for acute pneumonia
Over‐the‐counter (OTC) medications, including mucolytics and antitussives, are commonly used by patients and recommended by healthcare staff as adjuncts in the treatment of pneumonia. In this review we found insufficient evidence to draw any conclusions about the efficacy of any OTCs taken as adjuncts for cough associated with acute pneumonia. Mucolytics may be beneficial but the lack of consistent evidence precludes recommending the routine use of mucolytics as an adjunct in the treatment of troublesome cough associated with pneumonia in children or adults.
