Acta Oto-Laryngologica
ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20
Acute Laryngitis in Adults: Results of Erythromycin Treatment Lucyna Schalén, Ingvar Eliasson, Sören Fex, Carl Kamme & Claes Schalén To cite this article: Lucyna Schalén, Ingvar Eliasson, Sören Fex, Carl Kamme & Claes Schalén (1992) Acute Laryngitis in Adults: Results of Erythromycin Treatment, Acta Oto-Laryngologica, 112:sup492, 55-57, DOI: 10.3109/00016489209136810 To link to this article: http://dx.doi.org/10.3109/00016489209136810
Published online: 08 Jul 2009.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioto20 Download by: [University of California, San Diego]
Date: 20 April 2016, At: 19:04
Acta Otolaryngol (Stockh) 1992; Suppl. 492: 55-57
Acute Laryngitis in Adults: Results of Erythromycin Treatment LUCYNA SCHALEN,' INGVAR ELIASSON,2 SdREN FEX,' CARL KAMME2 and CLAES SCHALEN2
'
From ihe Depariments of Oiolaryngology, Division of Phoniatrics, and =Medical Microbiology, University Hospital, Lund, Sweden
Downloaded by [University of California, San Diego] at 19:04 20 April 2016
Schalbn L, Eliasson I, Fex S, Kamme C, Schaltn C. Acute laryngitis in adults: Results of erythromycin treatment. Acta Otolaryngol (Stockh) 1992; Suppl 492: 55-57. Previous studies of acute laryngitis in adults have shown high nasopharyngeal isolation rates of B. catarrhah and H . injluenzae. Phenoxymethylpenicillin had no effect on the clinical course. In the present study, 106 patients with acute laryngitis were treated with erythromycin 0.5 g x 2 V or placebo. During the first week the isolation rate of B. catarrhalis was reduced from 60 to 10% in the erythromycin group compared to 34 to 27% in the placebo group ( p < 0.01). The elimination of H . injluenzae, isolated in 19% at the acute visit, did not differ between the two groups. As compared to controls, erythromycin treated patients reported significantly lower scores of subjective voice disturbance after 1 week and cough after 2 weeks. Laryngological examination and voice evaluation failed to reveal any differences between the groups. Key words: Luryngiiis acuia, voice disorder, Branhamella caiarrhalis, Haemophilus injluenzae, erythromycin.
INTRODUCTION Our earlier studies on acute laryngitis in adults have shown a high occurrence in the nasopharynx of Branhamella catarrhalis and Haemophilus infuenzae (1,2). Though few of the isolates were B-lactamase producing, treatment with phenoxymethylpenicillin proved to have no effect on the elimination of bacteria or on the clinical course (2). Due to its documented effect on B. catarrhalis in particular (3), erythromycin might theoretically be considered in the treatment of acute laryngitis. In the present, double-blind placebo-controlled study, the effect of erythromycin on signs and symptoms in acute laryngitis in adults was investigated. MATERIALS AND METHODS One hundred and six consecutive patients, all older than 17 years, with acute laryngitis preceded by an upper respiratory tract infection (URTI) of no more than 2 weeks' duration were included. Six patients were excluded since they missed out on one or more of the scheduled visits and one because of exanthema during treatment. The patients were randomly given either erythromycin (Abboticinm) 0.5 g x 2 or placebo for 5 days. Anamnestic data were collected at the acute visit according to a standard form. On the acute visit and one and two weeks later, otolaryngological examination was performed, a specimen for microbiological culture was taken from the nasopharynx, and a standardized voice record was obtained. The patient scored daily the degree of subjective symptoms on a scale 0-3. A convalescent voice sample was obtained 2-6 months later. Perceptual analysis of voice was performed by a listener group (4). RESULTS At the acute visit, the nasopharyngeal isolation rate of B. catarrhalis was 47% and of H. infiuenzae 19%. The recovery rate of B. catarrhalis was higher, 60%, in the erythromycin
,
r.
56 L. SchalPn et al. 4o
of isdates
30
20
Placebo
Fig. 1. Isolation rates of 8. catarrhah from nasopharynx in patients with acute laryngitis, treated with erythromycin or
Elythro
Placebo.
10
0
Downloaded by [University of California, San Diego] at 19:04 20 April 2016
Acute
1 week
2 weeks
Subjective score 2.5 2.0 1.5 1.o
2. Subjective scores of hoarseness in patients treated with erythromycin or placebo for acute I = slight, laryngitis. 0 = no, 2 = moderate, 3 = severe. Fig.
0.5
Whro
0 Acute
1 week
2 weeks
treated group than in the placebo group, 34%, whereas after one week B. catarrhalis was recovered in 10% only of the erythromycin treated patients as compared to 26.5% among the controls ( p < 0.001; Chi-square test). After two weeks the respective isolation rates did not differ (Fig. I). The elimination of H. influenzae was equal in the two groups. The clinical examination did not reveal any significant differences in reduction of laryngeal redness or oedema, rhinitis and pharyngitis between the patients treated with erythromycin or placebo. However, the patients treated with erythromycin reported significantly lower scores of voice disturbance already after one week as compared to the placebo group ( p < 0.05; Student’s t-test) (Fig. 2). At 2 weeks no such differences persisted. Coughing was more reduced after 2 weeks in the patients receiving erythromycin ( p < 0.05). The perceptual v,oice evaluation by a listener group did not show any significant differences between the patients receiving erythromycin or placebo.
DISCUSSION The high nasopharyngeal isolation rates of B. catarrhah and H. iefluenzae were consistent with two previous investigations in patients with acute laryngitis ( I , 2). We earlier reported that phenoxymethylpenicillin was without effect on this disorder (2). The present findings indicate that the elimination of B. catarrhalis in erythromycin treated patients resulted in more rapid improvement of subjective voice disorder than in the controls. The results thus
Acute larvnaitis in adults
Downloaded by [University of California, San Diego] at 19:04 20 April 2016
support a pathogenic role for B. catarrhalis in laryngitis. As expected, the elimination of H . influenzae was not significantly influenced by erythromycin.
Our study is the first to show any clinical effect of antibiotics on subjective voice complaints in acute laryngitis. However, improvement of voice quality, as judged by the listener group did not differ among the erythromycin and the placebo treated patients. Since acute laryngitis is usually self-limiting within 1-2 weeks, the general use of antibiotics in this condition may be questioned. In Sweden, antibiotics, though not recommended, are often prescribed for acute laryngitis. However, ecological aspects would seem to necessitate a restricted use of antibiotics in this common disorder. It is notable that in vitro resistance against both erythromycin and tetracycline among clinical strains of B. catarrhalis was recently reported (5). The differential diagnosis of dysphonia may often be difficult, and misuse of the diagnosis of acute laryngitis is common (6,7). It seems reasonable that erythromycin treatment be restricted to verified cases in whom rapid voice improvement may be desired, e.g. with repeated episodes of infectious laryngitis and/or high voice demands where longlasting dysphonia may be of particular concern. REFERENCES I. SchalCn L, Christensen P, Kamme C, Miorner H, Pettersson K-I, Schalen C. High isolation rate of Branhamella catarrhalis from the nasopharynx in adults with acute laryngitis. Scand J Infect Dis 1980; 12: 277-80. 2. Schaltn L, Christensen P, Eliasson I, Fex S, Kamme C, Schaltn C. Inefficacy of penicillin V in acute laryngitis in adults. Ann Otol Rhino1 Laryngol 1985; 9 4 14-7. 3. Forsgren A, Walder M. Activity of common antibiotics against Branhamella catarrhalis, Haemophilus injluenzae, pneumococci, group A streptococci and Staphylococcus aureus in 1983. Acta Otolaryngol (Stockh) 1984; SUPPI.407: 43-9. 4. Schaltn L, Andersson K, Becker K et al. Acute laryngitis in adults. Etiological and phoniatric aspects. Acta Otolaryngol (Stockh) 1982, Suppl 386: 203-5. 5. Brown BA, Wallace Jr RJ, Flanagan CW, Wilson RW, Luman JI, Redditt DS. Tetracycline and erythromycin resistance among clinical isolates of Branhamella catarrhalis. Antimicrob Ag Chemother 1989; 33: 1631-3. 6. Herteglrd S, Patienter med rostbesvar miiste foljas upp battre (in Swedish). Lakartidningen 1988; 85: 4616-8. 7. Schalen L, Andersson K, Eliasson I. Diagnosis of psychogenic dysphonia. Acta Otolaryngol (Stockh) 1992; Suppl 492: 110-2 (this supplement).
Address for correspondence: Lucyna Schalbn, Department of Otorhinolaryngology, Division of Phoniatrics, University Hospital, S-22185 Lund, Sweden
57
ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20
Acute Laryngitis in Adults: Results of Erythromycin Treatment Lucyna Schalén, Ingvar Eliasson, Sören Fex, Carl Kamme & Claes Schalén To cite this article: Lucyna Schalén, Ingvar Eliasson, Sören Fex, Carl Kamme & Claes Schalén (1992) Acute Laryngitis in Adults: Results of Erythromycin Treatment, Acta Oto-Laryngologica, 112:sup492, 55-57, DOI: 10.3109/00016489209136810 To link to this article: http://dx.doi.org/10.3109/00016489209136810
Published online: 08 Jul 2009.
Submit your article to this journal
Article views: 14
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioto20 Download by: [University of California, San Diego]
Date: 20 April 2016, At: 19:04
Acta Otolaryngol (Stockh) 1992; Suppl. 492: 55-57
Acute Laryngitis in Adults: Results of Erythromycin Treatment LUCYNA SCHALEN,' INGVAR ELIASSON,2 SdREN FEX,' CARL KAMME2 and CLAES SCHALEN2
'
From ihe Depariments of Oiolaryngology, Division of Phoniatrics, and =Medical Microbiology, University Hospital, Lund, Sweden
Downloaded by [University of California, San Diego] at 19:04 20 April 2016
Schalbn L, Eliasson I, Fex S, Kamme C, Schaltn C. Acute laryngitis in adults: Results of erythromycin treatment. Acta Otolaryngol (Stockh) 1992; Suppl 492: 55-57. Previous studies of acute laryngitis in adults have shown high nasopharyngeal isolation rates of B. catarrhah and H . injluenzae. Phenoxymethylpenicillin had no effect on the clinical course. In the present study, 106 patients with acute laryngitis were treated with erythromycin 0.5 g x 2 V or placebo. During the first week the isolation rate of B. catarrhalis was reduced from 60 to 10% in the erythromycin group compared to 34 to 27% in the placebo group ( p < 0.01). The elimination of H . injluenzae, isolated in 19% at the acute visit, did not differ between the two groups. As compared to controls, erythromycin treated patients reported significantly lower scores of subjective voice disturbance after 1 week and cough after 2 weeks. Laryngological examination and voice evaluation failed to reveal any differences between the groups. Key words: Luryngiiis acuia, voice disorder, Branhamella caiarrhalis, Haemophilus injluenzae, erythromycin.
INTRODUCTION Our earlier studies on acute laryngitis in adults have shown a high occurrence in the nasopharynx of Branhamella catarrhalis and Haemophilus infuenzae (1,2). Though few of the isolates were B-lactamase producing, treatment with phenoxymethylpenicillin proved to have no effect on the elimination of bacteria or on the clinical course (2). Due to its documented effect on B. catarrhalis in particular (3), erythromycin might theoretically be considered in the treatment of acute laryngitis. In the present, double-blind placebo-controlled study, the effect of erythromycin on signs and symptoms in acute laryngitis in adults was investigated. MATERIALS AND METHODS One hundred and six consecutive patients, all older than 17 years, with acute laryngitis preceded by an upper respiratory tract infection (URTI) of no more than 2 weeks' duration were included. Six patients were excluded since they missed out on one or more of the scheduled visits and one because of exanthema during treatment. The patients were randomly given either erythromycin (Abboticinm) 0.5 g x 2 or placebo for 5 days. Anamnestic data were collected at the acute visit according to a standard form. On the acute visit and one and two weeks later, otolaryngological examination was performed, a specimen for microbiological culture was taken from the nasopharynx, and a standardized voice record was obtained. The patient scored daily the degree of subjective symptoms on a scale 0-3. A convalescent voice sample was obtained 2-6 months later. Perceptual analysis of voice was performed by a listener group (4). RESULTS At the acute visit, the nasopharyngeal isolation rate of B. catarrhalis was 47% and of H. infiuenzae 19%. The recovery rate of B. catarrhalis was higher, 60%, in the erythromycin
,
r.
56 L. SchalPn et al. 4o
of isdates
30
20
Placebo
Fig. 1. Isolation rates of 8. catarrhah from nasopharynx in patients with acute laryngitis, treated with erythromycin or
Elythro
Placebo.
10
0
Downloaded by [University of California, San Diego] at 19:04 20 April 2016
Acute
1 week
2 weeks
Subjective score 2.5 2.0 1.5 1.o
2. Subjective scores of hoarseness in patients treated with erythromycin or placebo for acute I = slight, laryngitis. 0 = no, 2 = moderate, 3 = severe. Fig.
0.5
Whro
0 Acute
1 week
2 weeks
treated group than in the placebo group, 34%, whereas after one week B. catarrhalis was recovered in 10% only of the erythromycin treated patients as compared to 26.5% among the controls ( p < 0.001; Chi-square test). After two weeks the respective isolation rates did not differ (Fig. I). The elimination of H. influenzae was equal in the two groups. The clinical examination did not reveal any significant differences in reduction of laryngeal redness or oedema, rhinitis and pharyngitis between the patients treated with erythromycin or placebo. However, the patients treated with erythromycin reported significantly lower scores of voice disturbance already after one week as compared to the placebo group ( p < 0.05; Student’s t-test) (Fig. 2). At 2 weeks no such differences persisted. Coughing was more reduced after 2 weeks in the patients receiving erythromycin ( p < 0.05). The perceptual v,oice evaluation by a listener group did not show any significant differences between the patients receiving erythromycin or placebo.
DISCUSSION The high nasopharyngeal isolation rates of B. catarrhah and H. iefluenzae were consistent with two previous investigations in patients with acute laryngitis ( I , 2). We earlier reported that phenoxymethylpenicillin was without effect on this disorder (2). The present findings indicate that the elimination of B. catarrhalis in erythromycin treated patients resulted in more rapid improvement of subjective voice disorder than in the controls. The results thus
Acute larvnaitis in adults
Downloaded by [University of California, San Diego] at 19:04 20 April 2016
support a pathogenic role for B. catarrhalis in laryngitis. As expected, the elimination of H . influenzae was not significantly influenced by erythromycin.
Our study is the first to show any clinical effect of antibiotics on subjective voice complaints in acute laryngitis. However, improvement of voice quality, as judged by the listener group did not differ among the erythromycin and the placebo treated patients. Since acute laryngitis is usually self-limiting within 1-2 weeks, the general use of antibiotics in this condition may be questioned. In Sweden, antibiotics, though not recommended, are often prescribed for acute laryngitis. However, ecological aspects would seem to necessitate a restricted use of antibiotics in this common disorder. It is notable that in vitro resistance against both erythromycin and tetracycline among clinical strains of B. catarrhalis was recently reported (5). The differential diagnosis of dysphonia may often be difficult, and misuse of the diagnosis of acute laryngitis is common (6,7). It seems reasonable that erythromycin treatment be restricted to verified cases in whom rapid voice improvement may be desired, e.g. with repeated episodes of infectious laryngitis and/or high voice demands where longlasting dysphonia may be of particular concern. REFERENCES I. SchalCn L, Christensen P, Kamme C, Miorner H, Pettersson K-I, Schalen C. High isolation rate of Branhamella catarrhalis from the nasopharynx in adults with acute laryngitis. Scand J Infect Dis 1980; 12: 277-80. 2. Schaltn L, Christensen P, Eliasson I, Fex S, Kamme C, Schaltn C. Inefficacy of penicillin V in acute laryngitis in adults. Ann Otol Rhino1 Laryngol 1985; 9 4 14-7. 3. Forsgren A, Walder M. Activity of common antibiotics against Branhamella catarrhalis, Haemophilus injluenzae, pneumococci, group A streptococci and Staphylococcus aureus in 1983. Acta Otolaryngol (Stockh) 1984; SUPPI.407: 43-9. 4. Schaltn L, Andersson K, Becker K et al. Acute laryngitis in adults. Etiological and phoniatric aspects. Acta Otolaryngol (Stockh) 1982, Suppl 386: 203-5. 5. Brown BA, Wallace Jr RJ, Flanagan CW, Wilson RW, Luman JI, Redditt DS. Tetracycline and erythromycin resistance among clinical isolates of Branhamella catarrhalis. Antimicrob Ag Chemother 1989; 33: 1631-3. 6. Herteglrd S, Patienter med rostbesvar miiste foljas upp battre (in Swedish). Lakartidningen 1988; 85: 4616-8. 7. Schalen L, Andersson K, Eliasson I. Diagnosis of psychogenic dysphonia. Acta Otolaryngol (Stockh) 1992; Suppl 492: 110-2 (this supplement).
Address for correspondence: Lucyna Schalbn, Department of Otorhinolaryngology, Division of Phoniatrics, University Hospital, S-22185 Lund, Sweden
57
