NICE summary of review conclusions
The use of antibiotics in acute laryngitis has not been shown objectively to have any significant clinical benefit that can justify this use in clinical practice. Despite an overall paucity of evidence, treating acute laryngitis with conservative measures in the first instance is appropriate because antibiotics are associated with side effects and an increased incidence of antimicrobial resistance, which is costly and harmful to the population as a whole.
Not using antibiotics for acute laryngitis is likely to lead to productivity savings and reduce the risk of antimicrobial resistance without compromising the clinical care of individual patients.
The Implications for practice section of the Cochrane review stated:
Definitive recommendations cannot be made since evidence is only available from three randomised controlled trials (RCTs). Antibiotics appear to have no benefit in the treatment of acute laryngitis. Erythromycin may reduce voice disturbance at one week and cough at two weeks, measured subjectively, and fusafungine may improve the rates of cured patients at day five (it is unclear how this was measured), however we consider that these outcomes are not relevant in clinical practice. In addition, acute laryngitis requires laryngoscopic findings for a clear diagnosis as hoarseness by itself is not the sole criterion for the assessment of a disease.
Overall, there is no clear benefit for the primary outcome, which is objective assessment of voice quality, but some improvements are seen in subjective measures (i.e. cough, hoarseness of voice) that could be important to patients. However, we consider that these modest benefits from antibiotics may not outweigh their cost, adverse effects or negative consequences for antibiotic resistance patterns. The implications for practice are that prescribing antibiotics should not be done in the first instance as they will not objectively improve symptoms.’