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Efficacy of Ambroxol lozenges for pharyngitis: a meta-analysis.

Chenot JF, Weber P, Friede T - BMC Fam Pract (2014)

Bottom Line: Main outcome was a ratio of pain reduction measured repeatedly over 3 h compared to baseline on 6-item verbal rating scale.However, the additional benefits of ambroxol beyond three hours, remain unclear given that more than 50% of patients using mint flavoured lozenges for pain relief reported good or very good efficacy after 1 day compared to 69% with ambroxol.Ambroxol is a safe option for individual patients with mainly local symptoms asking for treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Practice, University Medicine Greifswald, Ellernholzstr, 1-2, 17487 Greifswald, Germany. jchenot@uni-greifswald.de.

ABSTRACT

Background: Ambroxol has a local anaesthetic action and is marketed for pain relief for sore throat. The objective is to examine the efficacy and safety of ambroxol for the relief of pain associated with acute uncomplicated sore throat.

Methods: A systematic review of the literature and meta-analysis. Selection criteria consisted of randomized controlled trials which compared ambroxol to placebo or any other treatment for sore throat. Two reviewers independently assessed for relevance, inclusion, and risk of bias. Weighted mean differences (WMDs) were calculated and are reported with corresponding 95% confidence intervals (CIs).

Results and conclusion: From 14 potentially relevant citations, five trials reported in three publications met the inclusion criteria, three of them were published twice. Ambroxol lozenges were compared in different dosages (5-30 mg) with mint flavoured lozenges and once with benzocaine. Main outcome was a ratio of pain reduction measured repeatedly over 3 h compared to baseline on 6-item verbal rating scale. A total of 1.772 adult patients participated in the trials. Pain intensity decreased in both study arms. A meta-analysis of the 5 controlled trials resulted in a difference in pain reduction compared to placebo of -0.11 (95% CI [-0.15, -0.07]; p < 0.0001) favouring ambroxol 20 mg. Quality of reporting of the studies was low. Ambroxol is slightly more effective in relieving pain in acute sore throat than mint flavoured lozenges over a period of 3 h. However, the additional benefits of ambroxol beyond three hours, remain unclear given that more than 50% of patients using mint flavoured lozenges for pain relief reported good or very good efficacy after 1 day compared to 69% with ambroxol. Ambroxol is a safe option for individual patients with mainly local symptoms asking for treatment.

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Forest plot of primary endpoint comparing Ambroxol 20 mg and 30 mg versus placebo.
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Figure 2: Forest plot of primary endpoint comparing Ambroxol 20 mg and 30 mg versus placebo.

Mentions: The Forest plots show the difference of pain reduction of ambroxol 20 mg and 30 mg over 3 h compared to placebo (Figure 2). The summary of the observed difference of pain reduction is -0.11 (CI95 [-0.15; -0.07]) for 20 mg and -0.17 (CI95 [-0.24; -0.10]) for 30 mg of ambroxol. Although it seems that Ambroxol 30 mg is more effective than 20 mg the difference is statistically not significant (p=0.15). The standardized mean differences are -0.34 (CI95 [-0.46; -0.23]) and -0.43 (CI95 [-0.62; -0.24]) for 20 mg and 30 mg of ambroxol, respectively. These translate into probabilities of 59% and 62% that the pain reduction is greater or faster with ambroxol compared to placebo. The two unpublished trials also reported statistically significant differences in pain relief favouring ambroxol 20 mg, but did not provide enough data to be included in this meta-analysis.


Efficacy of Ambroxol lozenges for pharyngitis: a meta-analysis.

Chenot JF, Weber P, Friede T - BMC Fam Pract (2014)

Forest plot of primary endpoint comparing Ambroxol 20 mg and 30 mg versus placebo.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3975147&req=5

Figure 2: Forest plot of primary endpoint comparing Ambroxol 20 mg and 30 mg versus placebo.
Mentions: The Forest plots show the difference of pain reduction of ambroxol 20 mg and 30 mg over 3 h compared to placebo (Figure 2). The summary of the observed difference of pain reduction is -0.11 (CI95 [-0.15; -0.07]) for 20 mg and -0.17 (CI95 [-0.24; -0.10]) for 30 mg of ambroxol. Although it seems that Ambroxol 30 mg is more effective than 20 mg the difference is statistically not significant (p=0.15). The standardized mean differences are -0.34 (CI95 [-0.46; -0.23]) and -0.43 (CI95 [-0.62; -0.24]) for 20 mg and 30 mg of ambroxol, respectively. These translate into probabilities of 59% and 62% that the pain reduction is greater or faster with ambroxol compared to placebo. The two unpublished trials also reported statistically significant differences in pain relief favouring ambroxol 20 mg, but did not provide enough data to be included in this meta-analysis.

Bottom Line: Main outcome was a ratio of pain reduction measured repeatedly over 3 h compared to baseline on 6-item verbal rating scale.However, the additional benefits of ambroxol beyond three hours, remain unclear given that more than 50% of patients using mint flavoured lozenges for pain relief reported good or very good efficacy after 1 day compared to 69% with ambroxol.Ambroxol is a safe option for individual patients with mainly local symptoms asking for treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Practice, University Medicine Greifswald, Ellernholzstr, 1-2, 17487 Greifswald, Germany. jchenot@uni-greifswald.de.

ABSTRACT

Background: Ambroxol has a local anaesthetic action and is marketed for pain relief for sore throat. The objective is to examine the efficacy and safety of ambroxol for the relief of pain associated with acute uncomplicated sore throat.

Methods: A systematic review of the literature and meta-analysis. Selection criteria consisted of randomized controlled trials which compared ambroxol to placebo or any other treatment for sore throat. Two reviewers independently assessed for relevance, inclusion, and risk of bias. Weighted mean differences (WMDs) were calculated and are reported with corresponding 95% confidence intervals (CIs).

Results and conclusion: From 14 potentially relevant citations, five trials reported in three publications met the inclusion criteria, three of them were published twice. Ambroxol lozenges were compared in different dosages (5-30 mg) with mint flavoured lozenges and once with benzocaine. Main outcome was a ratio of pain reduction measured repeatedly over 3 h compared to baseline on 6-item verbal rating scale. A total of 1.772 adult patients participated in the trials. Pain intensity decreased in both study arms. A meta-analysis of the 5 controlled trials resulted in a difference in pain reduction compared to placebo of -0.11 (95% CI [-0.15, -0.07]; p < 0.0001) favouring ambroxol 20 mg. Quality of reporting of the studies was low. Ambroxol is slightly more effective in relieving pain in acute sore throat than mint flavoured lozenges over a period of 3 h. However, the additional benefits of ambroxol beyond three hours, remain unclear given that more than 50% of patients using mint flavoured lozenges for pain relief reported good or very good efficacy after 1 day compared to 69% with ambroxol. Ambroxol is a safe option for individual patients with mainly local symptoms asking for treatment.

Show MeSH
Related in: MedlinePlus