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Antibiotics for the common cold and acute purulent rhinitis

Bruce Arroll 1, Tim Kenealy 1

1Department of General Practice and Primary Health Care, University of Auckland,

Auckland, New Zealand

Contact address: Bruce Arroll, Department of General Practice and Primary Health Care,University of Auckland, Private Bag 92019, Auckland, New Zealand.

b.arroll@cochraneprimarycare.org . b.arroll@auckland.ac.nz . (Editorial group: CochraneAcute Respiratory Infections Group .)

Cochrane Database of Systematic Reviews , Issue 4, 2008 (Status in this issue: Edited,commented )Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.DOI: 10.1002/14651858.CD000247.pub2This version first published online: 20 July 2005 in Issue 3, 2005. Re-published online withedits: 8 October 2008 in Issue 4, 2008. Last assessed as up-to-date: 28 April 2005. (Dates andstatuses? )

This record should be cited as: Arroll B, Kenealy T. Antibiotics for the common cold andacute purulent rhinitis. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.:CD000247. DOI: 10.1002/14651858.CD000247.pub2.

Abstract

BackgroundIt has long been believed that antibiotics have no role in treating common colds yet they areoften prescribed in the belief that they may prevent secondary bacterial infections. Given theincreasing concerns about antibiotic resistance it is important to examine the evidence for the

benefit of antibiotics for the common cold.

ObjectivesTo determine:(1) the efficacy of antibiotics, in comparison with placebo, for reducing general symptomsand specific nasopharyngeal symptoms of acute upper respiratory tract infections;(2) if antibiotics have any influence on acute purulent rhinitis;(3) whether antibiotics cause significant adverse outcomes in patients with acute upperrespiratory tract infections.

Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) ( The Cochrane

Library 2005, issue 1) which contains the Acute Respiratory Infection Group's SpecializedRegsiter; MEDLINE (January 1966 to March, Week 1, 2005); EMBASE (1980 to December2004), the Family Medicine Database (1908, volume 1 to 1993, volume 13; this database wasdiscontinued in 1993), and reference lists of articles, and we contacted principal investigators.

mailto:b.arroll@cochraneprimarycare.orgmailto:b.arroll@cochraneprimarycare.orgmailto:b.arroll@auckland.ac.nzmailto:b.arroll@auckland.ac.nzmailto:b.arroll@auckland.ac.nzhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/ARI/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/ARI/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/ARI/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/ARI/frame.htmlhttp://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/DatesStatuses.htmlhttp://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/DatesStatuses.htmlhttp://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/DatesStatuses.htmlhttp://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/DatesStatuses.htmlhttp://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/DatesStatuses.htmlhttp://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/DatesStatuses.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/ARI/frame.htmlhttp://www.mrw.interscience.wiley.com/cochrane/clabout/articles/ARI/frame.htmlmailto:b.arroll@auckland.ac.nzmailto:b.arroll@cochraneprimarycare.org

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Selection criteriaRandomised trials comparing any antibiotic therapy against placebo in people with acuteupper respiratory tract infections and with less than seven days of symptoms, or acute

purulent rhinitis less than ten days in duration.

Data collection and analysisBoth authors independently assessed trial quality and extracted data.

Main resultsAll analyses used the fixed-effect model unless otherwise stated. The overall quality of theincluded trials was variable. People receiving antibiotics did no better in terms of lack of cureor persistence of symptoms than those on placebo (relative risk (RR) 0.89, 95% confidenceinterval (CI) 0.77 to 1.04), based on a pooled analysis of six trials with a total of 1147

patients. Overall, the relative risk of adverse effects in the antibiotic group was RR 1.8 (95%CI 1.01 to 3.21), using a random-effects model. Adult patients had a significantly greater riskof adverse effects with antibiotics than with placebo (RR 2.62, 95% CI 1.32 to 5.18)

(random-effects model) while there was no greater risk in children (RR 0.91, 95% CI 0.51 to1.63). The pooled relative risk for persisting acute purulent rhinitis with antibiotics comparedto placebo was 0.57 (95% CI 0.37 to 0.87) (random-effects model), based on 6 studies with772 participants.

Authors' conclusionsThere is insufficient evidence of benefit to warrant the use of antibiotics for upper respiratorytract infections in children or adults. Antibiotics cause significant adverse effects in adults.The evidence on acute purulent rhinitis and acute clear rhinitis suggests a benefit forantibiotics for these conditions but their routine use is not recommended.

Plain language summary

The common cold is an infection of the upper respiratory tractColds are usually caused by viruses, which do not respond to antibiotics. However,antibiotics cause adverse effects, especially diarrhoea, and overuse can increase levels ofantibiotic resistance in the community. Results do not show any benefit from takingantibiotics for the common cold and adverse gastrointestinal effects are common. A runnynose with coloured discharge (acute purulent rhinitis) is associated with the common cold.Results suggest that antibiotics may improve this aspect but antibiotics are not recommendedas an initial treatment for this condition as most people get better without them.