INTRODUCTION: Acute bronchitis affects over 40/1000 adults a year in the UK. The causes are usually considered to be infective, but only around half of people have identifiable pathogens. The role of smoking or of environmental tobacco smoke inhalation in predisposing to acute bronchitis is unclear. One third of people may have longer-term symptoms or recurrence. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute bronchitis in people without chronic respiratory disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics, antibiotics (macrolides, tetracyclines, cephalosporins, penicillins, or trimethoprim-sulfamethoxazole [co-trimoxazole]), antihistamines, antitussives, beta(2) agonists (inhaled or oral), and expectorants/mucolytics.

INTRODUCTION: Acute bronchitis affects more than 40 in 1000 adults per year in the UK. The causes are usually considered to be infective, but only around half of people have identifiable pathogens. The role of smoking or of environmental tobacco smoke inhalation in predisposing to acute bronchitis is unclear. One third of people may have longer-term symptoms or recurrence. METHODS AND OUTCOMES: We conducted a systematic review, aiming to answer the following clinical question: What are the effects of treatments for acute bronchitis in people without chronic respiratory disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2015 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 420 studies. After deduplication and removal of conference abstracts, 306 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 245 studies and the further review of 61 full publications. Of the 61 full articles evaluated, three updated systematic reviews and three RCTs were added at this update. We performed a GRADE evaluation for 12 PICO combinations. CONCLUSIONS: In this systematic review we categorised the efficacy for six intervention-comparison combinations, based on information about the effectiveness and safety of the following interventions: antibiotics, antihistamines, antitussives, beta2 agonists (inhaled), and expectorants/mucolytics.

BACKGROUND: The benefits and risks of antibiotics for acute bronchitis remain unclear despite it being one of the most common illnesses seen in primary care. OBJECTIVES: To assess the effects of antibiotics in improving outcomes and to assess adverse effects of antibiotic therapy for people with a clinical diagnosis of acute bronchitis. SEARCH METHODS: We searched CENTRAL 2016, Issue 11 (accessed 13 January 2017), MEDLINE (1966 to January week 1, 2017), Embase (1974 to 13 January 2017), and LILACS (1982 to 13 January 2017). We searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 5 April 2017. SELECTION CRITERIA: Randomised controlled trials comparing any antibiotic therapy with placebo or no treatment in acute bronchitis or acute productive cough, in people without underlying pulmonary disease. DATA COLLECTION AND ANALYSIS: At least two review authors extracted data and assessed trial quality. MAIN RESULTS: We did not identify any new trials for inclusion in this 2017 update. We included 17 trials with 5099 participants in the primary analysis. The quality of trials was generally good. At follow-up there was no difference in participants described as being clinically improved between the antibiotic and placebo groups (11 studies with 3841 participants, risk ratio (RR) 1.07, 95% confidence interval (CI) 0.99 to 1.15). Participants given antibiotics were less likely to have a cough (4 studies with 275 participants, RR 0.64, 95% CI 0.49 to 0.85; number needed to treat for an additional beneficial outcome (NNTB) 6) and a night cough (4 studies with 538 participants, RR 0.67, 95% CI 0.54 to 0.83; NNTB 7). Participants given antibiotics had a shorter mean cough duration (7 studies with 2776 participants, mean difference (MD) -0.46 days, 95% CI -0.87 to -0.04). The differences in presence of a productive cough at follow-up and MD of productive cough did not reach statistical significance.Antibiotic-treated participants were more likely to be improved according to clinician's global assessment (6 studies with 891 participants, RR 0.61, 95% CI 0.48 to 0.79; NNTB 11) and were less likely to have an abnormal lung exam (5 studies with 613 participants, RR 0.54, 95% CI 0.41 to 0.70; NNTB 6). Antibiotic-treated participants also had a reduction in days feeling ill (5 studies with 809 participants, MD -0.64 days, 95% CI -1.16 to -0.13) and days with impaired activity (6 studies with 767 participants, MD -0.49 days, 95% CI -0.94 to -0.04). The differences in proportions with activity limitations at follow-up did not reach statistical significance. There was a significant trend towards an increase in adverse effects in the antibiotic group (12 studies with 3496 participants, RR 1.20, 95% CI 1.05 to 1.36; NNT for an additional harmful outcome 24). AUTHORS' CONCLUSIONS: There is limited evidence of clinical benefit to support the use of antibiotics in acute bronchitis. Antibiotics may have a modest beneficial effect in some patients such as frail, elderly people with multimorbidity who may not have been included in trials to date. However, the magnitude of this benefit needs to be considered in the broader context of potential side effects, medicalisation for a self limiting condition, increased resistance to respiratory pathogens, and cost of antibiotic treatment.

PURPOSE: Most patients with acute bronchitis who seek medical care are treated with antibiotics, although the effectiveness of this intervention is uncertain. We performed a meta-analysis of randomized, controlled trials to estimate the effectiveness of antibiotics in the treatment of acute bronchitis. SUBJECTS AND METHODS: English-language studies published January 1966 to April 1998 were retrieved using MEDLINE, bibliographies, and consultation with experts. Only randomized trials that enrolled otherwise healthy patients with a diagnosis of acute bronchitis, used an antibiotic in the treatment group and a placebo in the control group, and provided sufficient data to calculate an effect size were included. RESULTS: We identified eight randomized controlled trials that satisfied all inclusion criteria. These studies used one of three antibiotics (erythromycin, doxycycline, trimethoprim/sulfamethoxazole). The use of antibiotics decreased the duration of cough and sputum production by approximately one-half day (summary effect size 0.21; 95% CI, 0.05 to 0.36). For specific symptoms, there were nonsignificant trends favoring the use of antibiotics: a decrease of 0.4 days of purulent sputum (95% CI, -0.1 to 0.8), a decrease of 0.5 days of cough (95% CI, -0.1 to 1.1), and a decrease of 0.3 days lost from work (95% CI, -0.6 to 1.1). CONCLUSION: This meta-analysis suggests a small benefit from the use of the antibiotics erythromycin, doxycycline, or trimethoprim/sulfamethoxazole in the treatment of acute bronchitis in otherwise healthy patients. As this small benefit must be weighed against the risk of side effects and the societal cost of increasing antibiotic resistance, we believe that the use of antibiotics is not justified in these patients.

BACKGROUND: Acute bronchitis is one of the most common diagnoses made by primary care physicians. It is traditionally treated with antibiotics (although the evidence for their effectiveness is weak, and modest at best) and other even less effective treatments. Chinese medicinal herbs have also been used as a treatment. OBJECTIVES: This review aimed to summarise the existing evidence on the comparative effectiveness and safety of Chinese medicinal herbs for treating uncomplicated acute bronchitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4) which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 19 September 19, 2011), EMBASE (1988 to 19 September 2011) and CNKI and the Chinese Biomedical Database (CBM) (1980 to 19 September, 2011). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing Chinese medicinal herbs with placebo, antibiotics or other Western medicines for the treatment of uncomplicated acute bronchitis. DATA COLLECTION AND ANALYSIS: At least two review authors independently extracted data and assessed trial quality. MAIN RESULTS: In this updated review, 74 studies involving 6877 participants were reported as RCTs by the study authors. None of them met the inclusion criteria for this review. Out of the 74 trials, we identified 39 as non-RCTs and 35 compared different Chinese herbal medicines in the intervention and control groups. AUTHORS' CONCLUSIONS: There is insufficient quality data to recommend the routine use of Chinese herbs for acute bronchitis. Trial design limitations of the individual studies meant that we could not draw any conclusions about the benefits of Chinese herbs for acute bronchitis. In addition, the safety of Chinese herbs is unknown due to the lack of toxicological evidence for these herbs, although adverse events were reported in some case reports.

BACKGROUND: Despite a relatively large number of clinical studies comparing oral fluoroquinolones to one antibiotic class comparator, there is limited information on the relative efficacy of different fluoroquinolones. OBJECTIVE: To examine the efficacy and tolerability of oral fluoroquinolones in the treatment of mild to moderate community-acquired pneumonia, acute exacerbations of chronic bronchitis and sinusitis. METHODS: A systematic review was undertaken with a MEDLINE search for antibiotics and indications. Included studies met the following criteria: original study; random allocation to treatment groups; treatment with one of the following oral antibiotics - moxifloxacin, levofloxacin, ciprofloxacin, gatifloxacin; controlled by either placebo or an active comparator medication; double-blind, single-blind or open treatment; men and women (18 years of age and older); diagnosis of one of the three indications; and treatment duration of at least three days. Outcome measures included efficacy and safety. Comparative and single arm meta-analyses were conducted. Statistical differences in antibiotic success rates were evaluated. Pooled point estimates and 95% CIs for the comparative statistics (z-scores, P-values) and the single-arm analysis were examined to evaluate equivalence. RESULTS: The results of the comparative and single meta-analyses revealed no major differences between the new fluoroquinolones. This is not surprising because the clinical studies were designed to show equivalence versus their comparators. Few comparative evaluations were conducted due to a paucity of studies. In relation to other competitors, small differences were seen. CONCLUSIONS: Results indicate that, in general, fluoroquinolones had similar efficacy, overall safety and dropout rates.

OBJECTIVES: Despite the recognition of selection biases arising from the healthy worker effect in occupational mortality studies, the possibility of similar effects in occupational cohort studies on respiratory symptoms is not well known. Two mechanisms are responsible for the healthy worker effect in respiratory cohort studies. One is health-based selection of workers into employment (healthy him effect), and the other is health-based differential losses to follow-up (healthy worker survivor effect). The aim of the present paper was to estimate the magnitude of the healthy worker survivor effect in cohort studies of symptoms of chronic bronchitis. METHODS: A meta-analysis of occupational cohort studies of symptoms of chronic bronchitis was performed that included published articles identified in searches of the Medline bibliographic databases between 1980 and March 2001 and the reference lists of the located articles. RESULTS: Eight cohort studies were identified using an a priori selection criterion. The pooled odds ratio of the prevalence of chronic bronchitis for subjects leaving the cohorts was 1.23 when these subjects were compared with those who remained under study (95% confidence interval 1.04-1A4). CONCLUSIONS: The prevalence of respiratory symptoms among exposed workers may he underestimated if the healthy worker survivor effect is not taken into account

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From a double-blind randomized controlled trial by 32 general practitioners on 218 patients with chronic bronchitis it appeared that sulfametopyrazine given once a week over one winter reduced the number of respiratory illnesses and the loss of time from work to about half that of a control group. It had no effect on time off work in individual spells of illness nor on the amount and purulence of sputum. Side-effects were few and mild.

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