Does laryngitis require antibiotics?

From the Guidelines

Laryngitis typically does not require antibiotics. Most cases of laryngitis are caused by viral infections, such as parainfluenza, rhinovirus, influenza, and adenovirus, which antibiotics cannot treat 1. The routine empiric use of antibiotics in treating patients with dysphonia is unwarranted, as they are effective only in bacterial infections. Some key points to consider when managing laryngitis include:

• Resting your voice, staying hydrated, and using a humidifier to manage symptoms
• Trying over-the-counter pain relievers like acetaminophen or ibuprofen to alleviate discomfort
• Gargling with warm salt water (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water) for relief
• Avoiding unnecessary use of antibiotics, as they don't work against viruses and can contribute to antibiotic resistance 1 Antibiotics may be appropriate in select circumstances, such as in immunosuppressed patients or when a bacterial infection is confirmed by a healthcare provider 1. However, the misuse of antibiotics exposes patients and the healthcare system to unnecessary costs and risks, including side effects and the spread of antibiotic resistance. If symptoms persist beyond two weeks, worsen significantly, or if you experience difficulty breathing or swallowing, seek medical attention promptly.

From the Research

Laryngitis and Antibiotics

• The use of antibiotics in treating laryngitis is a topic of debate, with some studies suggesting that they may not be effective in treating the condition 2, 3, 4.
• A study published in 2017 found that in cases of infectious laryngitis, culture results demonstrated the presence of various bacteria, including Methicillin-sensitive Staphylococcus aureus (MSSA) and Methicillin-resistant Staphylococcus aureus (MRSA), and that multiple courses of prolonged antibiotics were needed to treat these infections 5.
• However, other studies have found that antibiotics appear to have no benefit in treating acute laryngitis, with no significant differences in objective voice scores or symptoms reported by patients 2, 3, 4.
• Some studies have suggested that erythromycin may reduce voice disturbance at one week and cough at two weeks when measured subjectively, but the clinical significance of these findings is unclear 2, 3, 4.
• A study published in 2015 found that fusafungine, an antibiotic, could increase the cure rate at day five, but the quality of the evidence was very low and the study had methodological problems 3.
• Another study published in 2015 found that azithromycin, a macrolide antibiotic, tended to be more effective in terms of lower incidence of treatment failure and adverse events than amoxycillin or amoxyclav in patients with acute bronchitis of a suspected bacterial cause, but the evidence was unclear and most studies were of unclear methodological quality 6.

Types of Laryngitis

• Infectious laryngitis, which is caused by bacteria, may require antibiotics, especially in cases where MSSA or MRSA are present 5.
• Acute laryngitis, which is often caused by viruses, does not appear to benefit from antibiotic treatment 2, 3, 4.
• The effectiveness of antibiotics in treating other types of laryngitis, such as chronic laryngitis, is not well established and may require further study.

Treatment Considerations

• The decision to use antibiotics in treating laryngitis should be based on a thorough evaluation of the patient's condition, including the presence of bacterial infection and the severity of symptoms 5.
• Antibiotics should not be prescribed as a first-line treatment for acute laryngitis, as they are unlikely to provide significant benefits and may contribute to antibiotic resistance 2, 3, 4.
• Further research is needed to determine the optimal treatment regimen for laryngitis, including the use of antibiotics, and to establish clear guidelines for clinicians 5, 2, 3, 4.