EFFECTS OF DOXYCYCLINE IN PATIENTS WITH ACUTE COUGH AND PURULENT SPUTUM - A DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL

Background. Acute cough with purulent sputum is a common complaint pre sented to general practitioners. Aim. A randomized, double blind, plac ebo controlled clincal trial was undertaken to determine the efficacy of doxycycline in persons aged 18 years and over presenting to 22 gene ral practices in the Netherlands with acute cough and purulent sputum. Method. Patients were excluded if they were pregnant, had an allergy or intolerance to tetracyclines, had severe dyspnoea and fine crackles on auscultation, purulent rhinitis together with maxillary tenderness , chronic airways disease, or had taken antibiotics in the previous tw o weeks. Patients entered in to the study were given oral doxycycline for 10 days, 200 mg on the first day, followed by 100 mg on the next n ine days, or placebo. Results. Duration of frequent daytime cough afte r entry was a mean of 1.5 days shorter in the group of 71 patients rec eiving doxycycline than in the group of 69 patients on placebo (4.7 da ys versus 6.2 days, respectively). In patients aged 55 years and over the mean duration of frequent daytime cough after entry was 4.1 days s horter in the group taking doxycycline than in the placebo group. Pati ents with a very frequent cough and who also felt ill at entry regaine d their normal daily activities 2.1 days earlier when using doxycyclin e than the control group. Conclusion. Doxycycline has small beneficial effects in patients with acute cough and purulent sputum. These benef icial effects are more prominent, and probably clinically relevant, in patients aged 55 years and over and in patients who cough very freque ntly and who also feel ill.