A systematic literature review published in the Annals of Emergency Medicine found that in children with a prolonged wet cough antibiotics may improve clinical cure and reduce progression of illness.

Study investigators searched Cochrane Airways Trials Register, CENTRAL, MEDLINE OvidSP, EMBASE OvidSP, ClinicalTrials.gov, and the World Health Organization trial portal and identified 3 randomized controlled trials comprising 190 patients that compared antibiotic use with placebo or no treatment in children aged <18 years with no known pulmonary conditions and a prolonged wet cough. Prolonged wet cough was defined as cough for >10 days with the presence of lower airway secretions. 

A meta-analysis of these trails found that antibiotics improved the clinical cure rate (number needed to treat for an additional beneficial outcome of 3). Antibiotics also decreased illness progression (number needed to treat for an additional beneficial outcome of 4). Of the studies included, 2 investigated the effects of treatment with amoxicillin/clavulanic acid, and the third studied the effect of erythromycin.

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The study investigators noted that these results differ from previous Cochrane Reviews, which suggested no benefits of antibiotics in the treatment of the common cold and bronchitis. They also cautioned that the results should not justify liberal antibiotic use because this meta-analysis only included 3 studies; 2 were deemed to have high or unclear bias. The inclusion of patients with a cough >10 days also presented a limitation, as patients with longer duration of symptoms may be more likely to benefit from treatments. There were also limitations in the meta-analysis because the studies included used different antibiotics, as well as different dosages and treatment duration.

According to the study investigators, while antibiotics may improve clinical cure and reduce progression of illness, further data is needed to “evaluate the specific duration of therapy with validated objective measures of outcome, subgroups such as individuals with allergic rhinitis and ongoing seasonal allergies, and the use of amoxicillin/clavulanic acid.” Further, they suggested that more data on the adverse effects of antibiotics in this population are needed.

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Long B, April MD. Are antibiotics effective in the treatment of children with prolonged wet cough? [published online November 13 2018]. Ann Emerg Med. doi:10.1016/j.annemergmed.2018.10.010