Pediatrics |

Antibiotics in URTI-Related Acute Cough: Analysis of Two Studies in Children FREE TO VIEW

Alessandro Zanasi, MD; Luigi Lanata, MD; Michela Bagnasco, MD; Federico Saibene, MD; Peter Dicpinigaitis, MD; Francesco De Blasio, MD; Giovanni Fontana, MD
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Dompè, Milano, Italy

Chest. 2013;144(4_MeetingAbstracts):784A. doi:10.1378/chest.1702663
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SESSION TITLE: Pediatric Pulmonary Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Acute cough is one of the most frequent symptoms, usually following viral URTI. The disproportionate use of antibiotics in children with URTI, evidenced from the literature, could lead to possible associated side effects, without any major beneficial effect. We could also state that an an early antibiotic prescription increases parental satisfaction, although URTI are generally self-limiting,.. We analyzed effectiveness of antibiotics vs symptomatic drugs therapy (antitussives and mucolitics) in two pediatric trials on URTI-related cough.

METHODS: The first trial was a retrospective study involving 59 children with acute moist cough. Children were treated with antibiotics or inhaled mucoactive drugs, and cough was measured on patient diary at fixed timepoints, by means of a verbal category descriptive (VCD) score. The second was a prospective observational study including 305 children who required specific pediatric consultation for acute cough. Severity, frequency and type of cough were assessed at baseline and after 6 days of treatment using a standardized questionnaire administered to parents.

RESULTS: In the prospective study children treated with antibiotics alone showed lower percentage of cough resolution after 6 days than patient treated with antitussive only, while no difference in cough resolution was detected between children treated with antitussive alone vs patients receiving a combination of antibiotics and antitussives, either for central and peripheral antitussives3. Consistently, in the retrospective series, patients treated with inhaled mucoactive drugs (sobrerol or N-acetylcysteine) showed a significant improvement after 7 days compared with the group receiving antimicrobial therapy (p<0,01). The use of peripheral antitussive levodropropizine demonstrated a statistically significant beneficial effect in terms of cough resolution as compared to centrally acting antitussive drugs (codeine or cloperastine) (47% vs. 28%, p = 0.0012).

CONCLUSIONS: This analysis showed that the effect of antibiotics on acute pediatric cough caused by URTI is inferior to symptomatic antitussive therapy.

CLINICAL IMPLICATIONS: Antibiotics are not generally useful for treating cough, both alone and in association with antitussives. The use of antibiotics demonstrated to be of little benefit, outweighed by possible adverse effects.

DISCLOSURE: Luigi Lanata: Employee: Medical Director Michela Bagnasco: Employee: Medical Manager Federico Saibene: Employee: MD Employee Francesco De Blasio: Consultant fee, speaker bureau, advisory committee, etc.: Cosultant fee The following authors have nothing to disclose: Alessandro Zanasi, Peter Dicpinigaitis, Giovanni Fontana

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