From the Guidelines
Antibiotics are not recommended for laryngitis as it is most commonly caused by viral infections, not bacterial ones. According to the clinical practice guideline on hoarseness (dysphonia) updated in 2018 1, dysphonia in most patients is caused by acute viral laryngitis, which is not a bacterial infection. The guideline states that antibiotics are effective only in bacterial infections, and their routine empiric use in treating patients with dysphonia is unwarranted.
Some key points to consider when evaluating the use of antibiotics for laryngitis include:
- Acute laryngitis is self-limited, with most patients experiencing symptomatic improvement within 7 to 10 days irrespective of treatment 1
- A Cochrane review found that antibiotics do not appear to be effective in treating acute laryngitis in terms of objective outcomes 1
- Misuse of antibiotics exposes patients and the health care system to unnecessary costs and can have side effects, including rash, abdominal pain, diarrhea, and vomiting 1
- Antibiotic over- and misuse contribute to bacterial antibiotic resistance, which has serious health and cost impacts 1
However, antibiotics may be appropriate in select circumstances, such as in immunosuppressed patients or those with bacterial infections. For example, laryngeal tuberculosis or atypical mycobacterial laryngeal infection may require antibiotic treatment 1. In such cases, the choice of antibiotic would depend on the specific infection and the patient's underlying health status. If a bacterial infection is strongly suspected, amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days or azithromycin 500 mg on day 1 followed by 250 mg daily for 4 more days could be considered, but only after establishing a diagnosis and weighing the potential benefits and risks of antibiotic treatment 1.
From the Research
Antibiotics for Laryngitis
- The effectiveness of antibiotics in treating acute laryngitis is still a topic of debate, with some studies suggesting that they may not be effective in improving objective outcomes 2, 3.
- However, some antibiotics such as erythromycin may be beneficial in reducing subjective symptoms like voice disturbance and cough 2, 3.
- Fusafungine, an antibiotic used in some countries, may also increase the cure rate at day five 2.
- It's worth noting that the quality of evidence for these findings is generally low due to limitations in study design and execution 2, 3.
Specific Antibiotics
- Penicillin V has been studied in the treatment of acute laryngitis, but no significant differences were found between the penicillin group and the placebo group 2, 3.
- Erythromycin has been shown to reduce voice disturbance at one week and cough at two weeks when measured subjectively 2, 3.
- Clindamycin and amoxicillin with clavulanate may be effective in preventing future episodes of acute pharyngo-tonsillitis and eradicating group A streptococci from the tonsils 4.
- Azithromycin has been studied in various respiratory infections, including bronchiectasis and acute otitis media, and has been shown to be effective in some cases 5, 6.