Conceptual framework of equity-focused implementation research for health programs (EquIR)

BACKGROUND

Implementation research is increasingly used to identify common implementation problems and key barriers and facilitators influencing efficient access to health interventions.

OBJECTIVE

To develop and propose an equity-based framework for Implementation Research (EquIR) of health programs, policies and systems.

METHODS

A systematic search of models and conceptual frameworks involving equity in the implementation of health programs, policies and systems was conducted in Medline (PubMed), Embase, LILACS, Scopus and grey literature. Key characteristics of models and conceptual frameworks were summarized. We identified key aspects of equity in the context of seven Latin American countries-focused health programs We gathered information related to the awareness of inequalities in health policy, systems and programs, the potential negative impact of increasing inequalities in disadvantaged populations, and the strategies used to reduce them.

RESULTS

A conceptual framework of EquIR was developed. It includes elements of equity-focused implementation research, but it also links the population health status before and after the implementation, including relevant aspects of health equity before, during and after the implementation. Additionally, health sectors were included, linked with social determinants of health through the "health in all policies" proposal affecting universal health and the potential impact of the public health and public policies.

CONCLUSION

EquIR is a conceptual framework that is proposed for use by decision makers and researchers during the implementation of programs, policies or health interventions, with a focus on equity, which aims to reduce or prevent the increase of existing inequalities during implementation.

[Morbidity and mortality in a series of patients suffering from intraperitoneal neoplasia treated with peritoneal cytoreduction and hyperthermic intraperitoneal chemotherapy at the Fundación Santa Fe de Bogotá Teaching Hospital (ONCOLGroup--ATIA study)]

BACKGROUND

The procedure of radical peritonectomy followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is considered the standard treatment for peritoneal cancers.

AIMS

To evaluate various outcomes in a cohort of patients with peritoneal tumors treated with HIPEC.

METHODS

Twenty-four patients consecutively treated with radical peritonectomy plus HIPEC within the time frame of November 2007 to July 2010 were enrolled; 15 (62%) had tumors of appendicular origin, 4 (16.7%) had primary peritoneal tumors, 2 had ovarian carcinomas and there was one case of colon cancer, one carcinosarcoma and one hemangioendothelioma. Mean age was 53 years (range: 26-68) and median follow-up was 14.2 months (range: 1-32). Demographic data, histology, peritoneal cancer index (PCI), surgical procedure characteristics, recurrence-free survival (RFS), and overall survival (OS) were all evaluated. Short-term morbidity and mortality were also determined.

RESULTS

Complete cytoreduction was achieved in 18 patients (75%). Mean PCI was 15 (<10: 41% and >10: 58%), and the median (range) for surgery duration, length of stay in the Intensive Care Unit, parenteral nutritional support, and hospital stay were 12,5 (7-20) hours, 11,4 (2-74) days, 13,8 (12-65) days, and 29,1 (10-90) days, respectively. One patient (4%) died 6 months after the procedure, due to multiple associated complications. Considerable morbidity was seen in 52% of cases, including thromboembolic events (41%), catheter-related bacteremia (29%), fistulas (29%), and nephrotoxicity (25%). Six patients (25%) recurred after a median of 21 months of RFS.

CONCLUSIONS

Cytoreductive surgery plus HIPEC in well-selected patients presenting with tumors that affect the peritoneum is a procedure that can be carried out in Colombia with an adequate safety and effectiveness profile. Mortality was similar to that reported in the international literature.

Influence of trial registration on reporting quality of randomized trials: study from highest ranked journals

OBJECTIVE

To evaluate the reporting quality of key methodological items of randomized control trials (RCTs) in 55 of the highest ranked journals.

STUDY DESIGN AND SETTING

A list of the highest top ranked journals was identified, and a search for detecting RCTs in those journals was made. Two hundred sixty four journals were screened and 55 of them were identified having at least one RCT. Three RCTs were randomly selected a priori from each journal; 148 RCTs were finally included. RCTs were assessed by two reviewers using the Consolidated Standards of Reporting Trials (CONSORT) statement.

RESULTS

Only 11 (8%) RCTs had all items adequately reported. In addition, 36% of RCTs reported that the study was registered in any trial registry. We found a significant difference in the quality of reporting for baseline characteristics, recruitment, participant's flow, and randomization implementation between those studies having reported the registration of their RCT in a trial registry and those that have not. Adherence to key methodological items of the CONSORT statement was as follows: sample size determination (60%), sequence generation (49%), allocation concealment (40%), and blinding (25%).

CONCLUSIONS

Reporting of varied CONSORT items remains suboptimal. Registration in a trial registry was associated with improved reporting. Further efforts to enhance RCT registration could contribute to this improvement.

Trastuzumab (H) treatment in patients (pts) with metastatic breast cancer (MBC): An observational retrospective study in four hospitals from Bogotá, Colombia (ONCOLGroup study)

e12016

Background: Breast cancer is the second most common cancer diagnosed in Colombian women, and approximately 26% of MBC are HER-2-positive in our population. The purpose of this study was to assess the characteristics and outcome of pts with HER-2-positive MBC treated with H-based therapy in Bogotá. Methods: This retrospective study included 119 pts treated between 2000 and 2007. Overall response rates (ORR), clinical benefit (CB), time to progression (TTP), and overall survival (OS) were estimated. Most common grade 2/3 toxicities are reported as well as variables that influenced survival. Results: Median age was 62 years (range, 37 to 75). Eighty-seven (73%) pts had recurrent disease and the rest had de novo MBC. Performance status was ≥70% in 114 pts, 66% had ≤2 metastatic sites, and 58% had hormone receptor positive disease. Previous adjuvant therapy before H included antracyclines in 68% and taxanes in 39% of the pts. H was part of the first-line therapy for MBC in 86.5% of the pts, leading to a 54% ORR in 103 evaluable pts. CB was 81% and median TTP was 6.1 months. (range, 1.2 to 26 mo). The most common toxicities in this setting included neutropenia ≥G3 (9%) and neuropathy ≥G3 (7%). H was given as part of second line therapy to 54 (45%) pts, but only 41 had evaluable disease. A 56% ORR was found in this subgroup, 85% CB and 4.7-month median of TTP. Grade ≥G3 hand-foot syndrome was the main toxicity (14%). Median OS after the diagnosis of MBC was 23 months (range, 1.6–93 mo), being longer for pts with HR-positive disease (p = 0.036), in pts with loco-regional relapse (p = 0.029), and in those older than 50 (p = 0.0025). Only two variables independently predicted OS: age (HR: 0.4, 95% CI: 0.35–0.93, p = 0.046) and HR status (HR: 0.7, 95% CI: 0.60–0.86, p = 0.040). Two pts (1.7%) had H-induced heart failure. Conclusions: H in combination with chemotherapeutic agents has been proved to be an effective and safe treatment for HER-2-positive MBC. The results from our series agreed with those reported in the medical literature and guarantee the regular use of H in Colombia.

No significant financial relationships to disclose.

Wood-smoke exposure (WSE) as a predictor of response and survival in erlotinib-treated advanced lung adenocarcinoma (ALA) patients (pts) (ONCOLGroup study)

e19052

Background: There is consistent information suggesting that long-term WSE constitutes a risk factor for lung cancer. More than 50 years of WSE was associated with non-small cell lung cancer (NSCLC). In Colombia the prevalence of WSE in areas having less economic development is approximately 24%. The aim of the study was to evaluate WSE as a predictor of response and survival in ALA pts. Methods: This study included 168 pts with ALA treated between 2002 and 2007 in four referring hospitals of Bogotá. Retrospectively, we estimated overall response rates (ORR), time to progression (TTP) and overall survival (OS) in a subgroup of pts with significant WSE (exposure >5 years for at least 4 hours/day) treated with erlotinib, and compared them with the non-WSE population treated with the same compound. Results: Median age was 66 years (range, 29–96), 53% were female, 39% had never been smokers, 24% of all cohort pts had been considerably exposed to WS and 45 pts had received erlotinib during disease treatment (as 2nd or 3rd line). Sixteen of these pts (F11/M5, PS ≥70% 9 pts) had been exposed to WS and 29 not so (F17/M12, PS ≥70% 22 pts); 10 pts having WSE had been smoking for a mean of 14pk/yr history. ORR to erlotinib was 7% and 32% in pts with and without WSE respectively (p = 0.02). TTP was significantly higher in pts treated with erlotinib with no history of WSE (4.9 mo. vs 1.7 mo., p = 0.034). and in those who had received this compound as second-line (vs erlotinib used as third line, p = 0.044). Among pts with WSE history, OS was 6.6 mo. (range, 5.8–7.3) for those treated with Erlotinib and 12.7 mo. (range, 10.2–17) for those not treated with this compound (p = 0.04). Multivariate analysis was carried out for determining the factors influencing mortality between pts with WSE; only PS (HR: 4.6, 95%CI: 1.2–29, p = 0.050) and gender (HR: 3.6, 95%CI: 2.7–18, p = 0.036) were significant. Conclusions: WSE was associated with a poorer response and survival in ALA pts treated with erlotinib in Colombia.

No significant financial relationships to disclose.

Myelophthisis in solid tumors: Old aspects, new concepts (ONCOLGroup study)

e20672

Background: Myelophthisis is a form of bone marrow failure due to replacement of hematopoietic tissue by abnormal tissue, most commonly metastatic carcinomas. This results in extramedullary hematopoiesis, typically in the spleen leading to premature release of hematopoietic cells into the circulation. Peripheral blood findings of myelophthisis may include nucleated red blood cells, tear drop forms, giant platelets, and immature leukocytes. Overall, this picture is usually called leukoerythroblastosis. Methods: This retrospective study included 89 patients (pts) with solid tumors and myelophtisis that had been treated from 1991 to 2006 in a single reference center in Bogotá. We made a detailed analysis of pts characteristics and outcomes. Results: Mean age was 47.5±17.2 years, there was homogeneous gender distribution (F46/M43) and 62% pts had a PS ≥60%. Twenty-seven pts (30%) had breast cancer, pathology followed by primary unknown tumours (21%), rabdomiosarcoma (10%), prostate adenocarcinoma (10%), gastric carcinoma (7%) and others (22%). At the time when myelophtisis was documented 72% and 50% of pts had osseous and visceral metastasis respectively; 81 pts presented anaemia (Hb 9.8 ± 1.2 gr/dl), mean platelet count was 174,000 and mean leukocyte count was 24,283 ± 5,447. Forty-three pts received chemotherapy following the diagnosis of medullar infiltration, and normal leukocyte count was being seen in 40% of them after such treatment. Nine episodes of febrile neutropenia were found; median overall survival (OS) following the diagnosis of neoplasia and myelophtisis were 13.8 months and 2.2 months respectively. The factors related to lower survival rate were the presence of Hb ≤8.5 gr/dl (HR: 0,54, CI95% 0,32–0,95; p = 0.04), >3 metastasis sites (HR: 0,67, CI95% 0,45–0,92; p = 0.03), visceral disease (HR: 0,72, CI95% 0,66–0,89; p = 0.04) and febrile neutropenia caused by chemotherapy (HR: 0,52, CI95% 0,37–0,60; p = 0.02). Conclusions: Myelophtisis is a serious condition modifying the OS of patients having solid tumours. Treatment for this subgroup should be selected bearing in mind its potential haematological toxicity.

No significant financial relationships to disclose.

Palliative endobronchial brachytherapy for non-small cell lung cancer

BACKGROUND

Non-small cell lung cancers (NSCLC) constitutes about 80% of all lung cancer cases. Although surgery is the only curative treatment of NSCLC, fewer than 20% of tumors can be radically resected. Radiotherapy is one of the main treatment modalities in lung cancer, contributing to both its cure and palliation. Endobronchial brachytherapy (EBB) has been used as one approach to improve local control either alone or in combination with other treatments.

OBJECTIVES

To assess the effectiveness of palliative EBB in increasing survival and to control thoracic symptoms in patients with advanced NSCLC compared with external beam radiation therapy (EBRT) or other alternative endoluminal treatments.

SEARCH STRATEGY

The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and other databases were searched, as were reference lists and handsearching of selected journals and conference proceedings.

SELECTION CRITERIA

Randomized controlled trials (RCTs) comparing different regimens of palliative EBB with EBRT or other endobronchial interventions in patients with advanced NSCLC.

DATA COLLECTION AND ANALYSIS

Thirteen RCTs were included. There were important differences in the doses of radiotherapy investigated, patient characteristics and the outcomes measured. Because of this heterogeneity no meta-analysis was attempted.

MAIN RESULTS

We found trials comparing EBB to EBRT alone, EBB plus EBRT to EBRT alone, EBB plus chemotherapy to EBB alone, EBB to Nd-YAG laser and comparisons between diverse fractionation schedules of high dose rate EBB. From the heterogeneous information obtained from several small RCTs, we concluded that EBRT alone is more effective for palliation of NSCLC symptoms than EBB alone. Our findings did not provide conclusive evidence to recommend EBB plus EBRT to relieve symptoms compared to EBRT alone. Overall, for the primary endpoint of survival there was no evidence of benefit for EBB compared to EBRT and Nd-YAG laser or for the combination of EBB with chemotherapy. Additionally, findings from one trial suggested that twice 7.4 Gy was superior to the four times per week 3.8 Gy schedule for mean time of local control and fatal haemoptysis. No significant differences were found for fatal haemoptysis as an adverse event of EBB.

AUTHORS' CONCLUSIONS

The evidence did not provide conclusive results that EBB plus EBRT improved symptom relief over EBRT alone. We were not able to provide conclusive evidence to recommend EBB with EBRT, chemotherapy or Nd-YAG laser. For patients previously treated by EBRT who are symptomatic from recurrent endobronchial central obstruction, EBB may be considered in selected cases.

Enemas during labour

BACKGROUND

The use of enemas during labour usually reflects the preference of the attending healthcare provider. However, enemas may cause discomfort for women and increase the costs of delivery.

OBJECTIVES

To assess the effects of enemas applied during the first stage of labour on infection rates in mothers and newborns, duration of labour, perineal wound dehiscence in the mother, perineal pain and faecal soiling.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2007), PubMed (1966 to December 2006), the Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2006, Issue 4), clinical trials registers (December 2006) and reference lists of articles.

SELECTION CRITERIA

Randomized controlled trials (RCTs) in which an enema was administered during the first stage of labour and which included assessment of possible neonatal or puerperal morbidity or mortality.

DATA COLLECTION AND ANALYSIS

Two review authors assessed studies for inclusion independently.

MAIN RESULTS

Three RCTs (1765 women) met the inclusion criteria. Meta-analysis revealed no significant differences for infection rates in puerperal women (2 RCTs; 594 women; relative risk (RR) 0.66, 95% CI 0.42 to 1.04) or newborn children (1 RCT; 370 newborns; RR 1.12, 95% CI 0.76 to 1.67) after one month of follow up. No significant differences were found in the incidence of lower or upper respiratory tract infections. One trial described labour to be significantly shorter with enema versus no enema (1 RCT, 1027 women; 409.4 minutes versus 459.8 minutes; weighted mean difference (WMD) -50,40 CI 95% -75.68 to -25.12; P < 0.001), but another, adjusted for parity, did not confirm this (median 515 minutes with enemas versus 585 minutes without enemas, P = 0.24). Two trials found no significant differences in neonatal umbilical infection (2 RCTs; 592 newborns; RR 3.16 95% CI 0.50 to 19.82). The one trial that researched women's views found no significant differences in satisfaction between groups.

AUTHORS' CONCLUSIONS

The evidence provided by the three included RCTs shows that enemas do not have a significant effect on infection rates such as perineal wound infection or other neonatal infections and women's satisfaction. This evidence does not support the routine use of enemas during labour; therefore, such practice should be discouraged.

Treatments for iron-deficiency anaemia in pregnancy

BACKGROUND

Iron deficiency, the most common cause of anaemia in pregnancy worldwide, can be mild, moderate or severe. Severe anaemia can have very serious consequences for mothers and babies, but there is controversy about whether treating mild or moderate anaemia provides more benefit than harm.

OBJECTIVES

To assess the effects of different treatments for iron-deficiency anaemia in pregnancy (defined as haemoglobin less than 11 g/dl) on maternal and neonatal morbidity and mortality.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to December 2005), EMBASE (1976 to December 2005), LILACS (1982 to 40 edition), BIOSIS Previews (1980 to June 2002) and ongoing clinical trial registers.

SELECTION CRITERIA

Randomised controlled trials comparing treatments for iron-deficiency anaemia in pregnancy.

DATA COLLECTION AND ANALYSIS

We identified 17 trials, involving 2578 women. We assessed trial quality.

MAIN RESULTS

The trials were small and generally methodologically poor. They covered a very wide range of differing drugs, doses and routes of administration, making it difficult to pool data. Oral iron in pregnancy showed a reduction in the incidence of anaemia (one trial, 125 women; relative risk 0.38; 95% confidence interval 0.26 to 0.55). It was not possible to assess the effects of treatment by severity of anaemia. A trend was found between dose and reported adverse effects. We found that most trials had no assessments on relevant clinical outcomes and a paucity of data on adverse effects, including some that are known to be associated with iron administration. Although the intramuscular and intravenous routes produced better haematological indices in women than the oral route, no clinical outcomes were assessed and there were insufficient data on adverse effects, for example, on venous thrombosis and severe allergic reactions.

AUTHORS' CONCLUSIONS

Despite the high incidence and burden of disease associated with this condition, there is a paucity of good quality trials assessing clinical maternal and neonatal effects of iron administration in women with anaemia. Daily oral iron treatment improves haematological indices but causes frequent gastrointestinal adverse effects. Parenteral (intramuscular and intravenous) iron enhances haematological response, compared with oral iron, but there are concerns about possible important adverse effects. Large, good quality trials, assessing clinical outcomes (including adverse effects) are required.

Interventions for pityriasis rosea

BACKGROUND

Pityriasis rosea is a scaly rash that mainly affects young adults. It can be very itchy but most people recover within 2 to 12 weeks.

OBJECTIVES

To assess the effects of interventions for pityriasis rosea.

SEARCH STRATEGY

We searched the Cochrane Skin Group Specialised Register (December 2004), the Cochrane Central Register of Controlled Clinical Trials in The Cochrane Library (Issue 4, 2004), MEDLINE (1966 to January 2005), EMBASE (1976 to January 2005), LILACS (1982 to January 2005), BIOSIS Preview (1980 to June 2002), and ongoing trials databases. We scanned bibliographies of published studies, abstracts from dermatology conference proceedings, corresponded with trialists and contacted the pharmaceutical industry.

SELECTION CRITERIA

Randomised controlled trials evaluating interventions for pityriasis rosea.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial quality and extracted data. We contacted study authors to retrieve missing data.

MAIN RESULTS

Three trials involving 148 people were included. One poor quality trial (23 people), compared intravenous glycyrrhizin and intravenous procaine. It found no significant difference between the two interventions for treating symptoms and rash. One fair quality trial (85 people), compared the oral antihistamine dexchlorpheniramine (4 mg), the oral steroid betamethasone (500 mcg), and a combination of betamethasone (250 mcg) and dexchlorpheniramine (2 mg). It found no significant difference in itch resolution at two weeks, as rated by the participants, between dexchlorpheniramine and betamethasone, and the combination of dexchlorpheniramine and betamethasone. However, both dexchlorpheniramine and betamethasone alone seem to be better at clearing rash than the combination of dexchlorpheniramine and betamethasone. These interventions were not compared with placebo. The small good quality trial (40 people) that compared oral erythromycin and placebo found that erythromycin was more effective than placebo in terms of rash improvement, as rated by the trialists, after two weeks (RR 13.00; 95% CI 1.91 to 88.64). It was also more effective in decreasing the itch score (difference of 3.95 points, 95% CI 3.37 to 4.53). No serious adverse effects were reported for the interventions. Two out of 17 people on oral erythromycin and 1 out of 17 on placebo reported minor gastrointestinal upset.

AUTHORS' CONCLUSIONS

We found inadequate evidence for efficacy for most treatments for pityriasis rosea. Oral erythromycin may be effective in treating the rash and decreasing the itch. However, this result should be treated with caution since it comes from only one small RCT. More research is necessary to evaluate the efficacy of erythromycin and other treatments.

Antibiotics for acute laryngitis in adults

BACKGROUND

Acute laryngitis is a common illness worldwide. Diagnosis is often made by case history alone and treatment is often directed towards controlling symptoms.

OBJECTIVES

The aim of this review was to assess the effectiveness of different antibiotic therapies in adults suffering acute laryngitis. A secondary objective was to report the rates of adverse events associated with these treatments.

SEARCH STRATEGY

We systematically screened the following electronic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2006); MEDLINE (January 1966 to December Week 2 2006); and EMBASE (1974 to June 2006), LILACS (from 1982 to December 2006 ) and BIOSIS (1980 to June 2002). Other strategies included hand searching relevant journals, searching ongoing trial databases and general databases such as Google scholar.

SELECTION CRITERIA

Randomized controlled trials comparing any antibiotic therapy with placebo in acute laryngitis. The main outcome measurement was objective voice scores.

DATA COLLECTION AND ANALYSIS

Data were independently extracted by two review authors and then descriptively synthesized.

MAIN RESULTS

Only two trials met study inclusion criteria after extensive literature searches. One hundred participants were randomly selected to receive either penicillin V (800 mg twice a day for five days), or an identical placebo, in a study of penicillin V in acute laryngitis in adults. A tape recording of each patient reading a standardized text was obtained during the first visit, subsequently during re-examination after one and two weeks, and at follow up after two to six months. No significant differences were found between the groups. The trial also measured symptoms reported by participants and found no significant differences. The second trial investigated erythromycin for treating acute laryngitis in 106 adults. The mean objective voice scores measured at the first visit, at re-examination after one and two weeks, and at follow up after two to six months did not significantly differ between control and intervention groups. At one week there were significant beneficial differences in the severity of reported vocal symptoms as judged by the participants (P = 0.042). Comparing the erythromycin and placebo groups on subjective voice scores the a priori relative risk (RR) was 0.7 (95% confidence interval (CI) 0.51 to 0.96, P = 0.034) and the number needed to treat (NNT) was 4.5.

AUTHORS' CONCLUSIONS

Antibiotics appear to have no benefit in treating acute laryngitis. Erythromycin could reduce voice disturbance at one week and cough at two weeks when measured subjectively. We consider that these outcomes are not relevant in clinical practice. The implications for practice are that prescribing antibiotics should not be done in the first instance as they will not objectively improve symptoms.

Antibiotics for acute laryngitis in adults

BACKGROUND

Acute laryngitis is a common illness worldwide. Diagnosis is often made by case history alone and treatment is often directed towards controlling symptoms.

OBJECTIVES

The aim of this review was to assess the effectiveness of different antibiotic therapies in adults suffering acute laryngitis. A secondary objective was to report the rates of adverse events associated with these treatments.

SEARCH STRATEGY

We systematically screened the following electronic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (January 1966 to June Week 3 2004); and EMBASE (1974 to June 2004), LILACS (from 1982 to the 40th edition) and BIOSIS (1980 to June 2002). Other strategies included hand searching relevant journals, searching ongoing trial databases and general databases such as Alta Vista.

SELECTION CRITERIA

Randomized controlled trials comparing any antibiotic therapy with placebo in acute laryngitis. The main outcome measurement was objective voice scores.

DATA COLLECTION AND ANALYSIS

Data were independently extracted by two people and then descriptively synthesised.

MAIN RESULTS

Only two trials met study inclusion criteria after extensive literature searches. One hundred patients were randomly selected to receive either penicillin V (800 mg twice a day for five days), or an identical placebo, in a study of penicillin V in acute laryngitis in adults. A tape recording of each patient reading a standardised text was obtained during the first visit, subsequently during re-examination after one and two weeks, and at follow up after two to six months. No significant differences were found between the groups. The trial also measured symptoms reported by patients and found no significant differences. The second trial investigated erythromycin for treating acute laryngitis in 106 adults. The mean objective voice scores measured at the first visit, at re-examination after one and two weeks, and at follow up after two to six months did not significantly differ between control and intervention groups. At one week there were significant beneficial differences in the severity of reported vocal symptoms as judged by the patients (p = 0.042). Comparing the erythromycin and placebo groups on subjective voice scores the a priori relative risk (RR) was 0.7 (95% confidence interval (CI) 0.51 to 0.96, p = 0.034) and the number needed to treat (NNT) was 4.5.

AUTHORS' CONCLUSIONS

Antibiotics appear to have no benefit in treating acute laryngitis. Erythromycin could reduce voice disturbance at one week and cough at two weeks when measured subjectively. We consider that these outcomes are not relevant in clinical practice. The implications for practice are that prescribing antibiotics should not be done in the first instance as they will not objectively improve symptoms.