Antibiotics for Acute Laryngitis in Adults

Clinical Question

Are antibiotics effective for the treatment of acute laryngitis in adults?

Evidence-Based Answer

Two small trials of antibiotic treatment in acute laryngitis do not support routine use of antibiotics in these patients. Most patients will feel better in five to seven days, and it is unlikely that they will experience a clinically important benefit from antibiotics.

Practice Pointers

Laryngitis is characterized by hoarseness accompanied by varying degrees of sore throat, congestion, and other symptoms of upper respiratory tract infection. Although it usually is a viral infection, bacteria such as Haemophilus influenzae, Chlamydia pneumoniae, Moraxella catarrhalis, and Streptococcus pneumoniae have been isolated from the respiratory tract of symptomatic patients. Whether the bacteria are the cause of infection and whether treatment with antibiotics improves symptoms is not clear. Nevertheless, many physicians routinely prescribe antibiotics for adults with laryngitis. Reveiz and colleagues reviewed the literature to assess the effectiveness of different antibiotics for the treatment of acute laryngitis in adults, and to report any associated adverse effects.

Despite an extensive review, only two relevant clinical trials were identified. They were conducted by the same group of Swedish researchers and were published in 1985 and 1993. In the first trial, penicillin V (800 mg) or placebo was given twice daily for five days to 100 adults with laryngitis. Symptoms reported by the patients and a blinded assessment of voice quality were recorded for up to six months. There was no significant difference found between antibiotic and placebo groups for any of the measured outcomes.

The second study compared erythromycin with placebo. The authors found a small benefit in voice after one week (number needed to treat = five) and an improvement in reported cough symptoms at two weeks in the treatment group. Adverse events were not reported.

The poor quality of the literature for such a common condition is similar to that for bronchitis and other upper respiratory tract infections. Even patients with purulent secretions usually have viral infections and do not benefit from antibiotics.1

Follow-up After Surgically Treated Breast Cancer

Clinical Question

What follow-up should women have after surgical treatment of breast cancer?

Evidence-Based Answer

The best available evidence supports clinical breast examinations every three to six months for five years and annual mammography for asymptomatic breast cancer survivors. More intensive follow-up and subspecialist visits do not improve survival.

Practice Pointers

Rojas and colleagues identified four studies that compared different approaches to follow-up in 3,055 women who were surgically treated for Stage I, II, or III breast cancer. Two studies (2,563 women) compared a minimal follow-up strategy (i.e., clinical breast examination every three to six months and annual mammography) with more intensive follow-up that included laboratory and imaging tests such as chest radiograph and bone scan in addition to regular examinations. After five to 10 years, the studies found no difference in overall mortality (relative risk [RR], 0.98; 95 percent confidence interval [CI], 0.84 to 1.15) or quality of life between groups. One study found a benefit in disease-free survival in the intensive follow-up group (bone scan and chest radiograph every six months), though the other did not. The pooled RR for disease-free survival for both studies was 0.84 (P = .05; 95 percent CI, 0.71 to 1.00).

One study with 296 women compared hospital-based subspecialist follow-up with follow-up by the patient’s family physician. There was no significant difference in the likelihood of recurrence (7 percent with family physicians versus 11 percent with subspecialists) and patients reported more satisfaction with care from their family physician. A limitation of these studies is their age, but recent evidence-based guidelines are consistent with their findings. The Institute for Clinical Systems Improvement1 and the National Comprehensive Cancer Network2 also recommend clinical breast examinations every four to six months for five years, then annually, with annual mammograms for asymptomatic breast cancer survivors. They do not recommend routine laboratory or imaging studies for asymptomatic women who are not expected to have a recurrence.