New research suggests that antibiotics are not effective in treating cough due to the common cold in children. The study, presented at CHEST 2012, the annual meeting of the American College of Chest Physicians, found that when children with acute cough were treated with either antitussive medication or antibiotics, antibiotics alone showed a lower percentage of cough resolution.
"In our experience, antibiotics are often prescribed by the general practitioner to treat cough in children, many times to pacify parents," says lead study author Francesco de Blasio, MD, FCCP, Clinic Center Private Hospital, Naples, Italy. "However, antibiotics show very little effectiveness at treating cough due to your average head cold."
To understand how antibiotics were being used in a clinical pediatric setting, de Blasio and colleagues from the University of Bologna and Dompé SPA in Italy observed the treatment and outcomes of 305 children who required pediatric consultation due to acute cough from the common cold. Of the children, 89 received antibiotics only, while 38 received a combination of antibiotics and antitussives; central (codeine and cloperastine) in 16 cases, and peripheral (levodropropizine) in 22 children. Forty-four and 79 children received only central or peripheral antitussives, respectively, without antibiotics; 55 children did not receive medication.
Observational results showed no difference in percentage of cough resolution between children treated with antitussive alone vs children receiving a combination of antibiotics and antitussives. On the contrary, children treated with antibiotics only had a lower percentage of cough resolution than children treated with antitussive only. Furthermore, the use of the peripheral antitussive levodropropizine demonstrated a significant beneficial effect in terms of cough resolution compared with centrally acting antitussive drugs (47 percent vs 28 percent).
"Few drugs are effective as cough suppressants, and antibiotics are no more effective in relieving cough than the use of no medication," he says. "However, peripheral antitussives, such as levodropropizine, appear to be the best option at relieving cough."
de Blasio's results support the American College of Chest Physicians evidence-based guidelines for the diagnosis and management of cough, published in the journal CHEST in 2006, which recommend the use of peripheral antitussives for certain types of cough. Although antibiotics may not be an effective therapy for cough, they can be useful in treating underlying infections that may produce cough, adds de Blasio. But he warns that antibiotics should not be overused. "Using antibiotics as a treatment for cough without suspected infection is unnecessary and can be harmful," explains de Blasio. "Repeated use of antibiotics, especially when they are ineffective, can lead to adverse allergic reactions or a resistance to the medications."
"As parents, it is difficult to watch our children suffering from a terrible cough, but turning to antibiotics is not always the answer," says ACCP president-elect Darcy D. Marciniuk, MD, FCCP. "Depending on the underlying cause of the cough, a health-care professional can recommend the best treatment options for a child, which, in some cases, may be no treatment."