A Cochrane review [Abstract] 1 included three studies with a total of 351 subjects.
In one trial, 100 patients were randomly selected to receive either penicillin V (800 mg twice a day for 5 days), or an identical placebo. A tape recording of a standardised text was obtained from each patient during the first visit, after one and two weeks and after two to six months. No significant differences were found between the groups, and neither in symptoms reported by the patients.
The second trial investigated erythromycin for treating acute laryngitis in 106 adults. Objective voice scores were measured like in the first trial and showed no significant difference between control and intervention groups. At one week there were significant beneficial differences in the severity of reported vocal symptoms as judged by the patients (p=0.042). Comparing the erythromycin and placebo groups on subjective voice scores the a priori relative risk (RR) was 0.7 (95% CI 0.51 to 0.96, p=0.034) and the number needed to treat (NNT) was 4.5. These outcomes are not relevant in clinical practice as the modest benefits from antibiotics may not outweigh their cost, adverse effects, or negative consequences on antibiotic resistance patterns.
A third trial from Russia included 145 patients with acute laryngitis symptoms. Participants were randomised to three treatment groups: Group 1: seven-day course of fusafungine (six times a day by inhalation); Group 2: seven-day course of fusafungine (six times a day by inhalation) plus clarithromycin (250 mg twice daily for seven days); Group 3: no treatment. Clinical cure rates were measured at days 5 ± 1, 8 ± 1 and 28 ± 2. The authors reported significant differences in the rates of clinical cure at day 5 ± 1 favouring fusafungine (one trial; 93 participants; RR 1.50, 95% CI 1.02 to 2.20; P value = 0.04) and fusafungine plus clarithromycin (one trial 97 participants; RR 1.47, 95% CI 1.00 to 2.16; P value = 0.05) when compared to no treatment. However, no significant differences were found at days 8 ± 1 and 28 ± 2. Also, no significant differences were found when comparing fusafungine to fusafungine plus clarithromycin at days 5 ± 1, 8 ± 1 and 28 ± 2.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).
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