Pillay-Van Wyk Victoria, Swingler George H
Epidemiology, Strategic Research and Health Policy (13th Floor), Social Aspects of HIV/AIDS Research Programme, Human Sciences Research Council, Private Bag X9182, Cape Town, Cape Town, South Africa, 8000.
Cochrane Database Syst Rev. 2008 Oct 8(4):CD003257. doi: 10.1002/14651858.CD003257.pub2.
Whooping cough is an important cause of childhood morbidity and mortality. There are 20 to 40 million cases of whooping cough annually world-wide, 90% of which occur in developing countries, resulting in an estimated 200 to 300,000 fatalities each year. Much of the morbidity is due to the effects of the paroxysmal cough. Corticosteroids, salbutamol (beta 2 - adrenergic stimulant), and pertussis-specific immunoglobulin have been proposed as standard treatment for the cough. Antihistamines have also been administered. No systematic review of the effectiveness of any of these interventions or others has been performed.
To assess the effectiveness and safety of interventions used to reduce the severity of the coughing paroxysms in whooping cough in children and adults.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2003, issue 2); MEDLINE (January 1966 to June 2003); EMBASE (1990 to June 2003) and LILACS (1982 to November 2001).
Randomised and quasi-randomised controlled trials of any intervention aimed at suppressing the cough in whooping cough; excluding antibiotics and vaccines.
Two review authors independently selected studies and extracted data. Our primary outcome was frequency of paroxysms of coughing. Secondary outcomes were frequency of vomiting, frequency of whoop, frequency of cyanosis, development of serious complications, mortality from any cause, side effects due to medication, admission to hospital and duration of hospital stay. Disagreements were resolved by discussion.
Nine studies satisfied the inclusion criteria but four had insufficient data for meta - analysis of pre-specified outcomes. Studies were small and poorly reported. The largest study had a sample size of 49 and the smallest study 18. All studies were performed in industrialised settings.Eligible studies assessed diphenhyramine, pertussis immunoglobulin, dexamethasone and salbutamol. No statistically significant benefit was found for any of the interventions. Diphenhydramine did not change coughing spells (mean increase of coughing spells per 24 hours 1.9 with 95% CI - 4.7 to 8.5) and pertussis immunoglobulin no change in hospital stay (0.7 days, 95% CI -3.8 to 2.4), and a mean reduction of 3.1 whoops per 24 hours (95% CI -6.2 to 0.02). Dexamethasone did not show a clear decrease in hospital stay (-3.5 days, 95% CI - 15.3 to 8.4) and salbutamol showed no change in coughing paroxysms per 24 hours (-0.22, 95% CI - 4.13 to 3.69).
AUTHORS' CONCLUSIONS: Insufficient evidence exists to draw conclusions about the effects of any intervention for the cough in whooping cough.
百日咳是儿童发病和死亡的一个重要原因。全球每年有2000万至4000万例百日咳病例，其中90%发生在发展中国家，每年估计有20万至30万人死亡。大部分发病是由于阵发性咳嗽的影响。皮质类固醇、沙丁胺醇（β2-肾上腺素能兴奋剂）和百日咳特异性免疫球蛋白已被提议作为咳嗽的标准治疗方法。也使用了抗组胺药。尚未对这些干预措施或其他措施的有效性进行系统评价。
评估用于减轻儿童和成人百日咳咳嗽发作严重程度的干预措施的有效性和安全性。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（Cochrane图书馆2003年第2期）；MEDLINE（1966年1月至2003年6月）；EMBASE（1990年至2003年6月）和LILACS（1982年至2001年11月）。
任何旨在抑制百日咳咳嗽的干预措施的随机和半随机对照试验；不包括抗生素和疫苗。
两名综述作者独立选择研究并提取数据。我们的主要结局是咳嗽发作的频率。次要结局包括呕吐频率、哮吼声频率、发绀频率、严重并发症的发生、任何原因导致的死亡率、药物副作用、住院情况及住院时间。通过讨论解决分歧。
9项研究符合纳入标准，但4项研究缺乏数据，无法对预先设定的结局进行荟萃分析。研究规模小且报告质量差。最大的研究样本量为49，最小的研究样本量为18。所有研究均在工业化国家进行。符合条件的研究评估了苯海拉明、百日咳免疫球蛋白、地塞米松和沙丁胺醇。未发现任何干预措施有统计学意义的益处。苯海拉明未改变咳嗽发作次数（每24小时咳嗽发作次数平均增加1.9次，95%可信区间为-4.7至8.5），百日咳免疫球蛋白未改变住院时间（0.7天，95%可信区间为-3.8至2.4），每24小时哮吼声平均减少3.1次（95%可信区间为-6.2至0.02）。地塞米松未显示住院时间明显缩短（-3.5天，95%可信区间为-15.3至8.4），沙丁胺醇未显示每24小时咳嗽发作次数有变化（-0.22，95%可信区间为-4.13至3.69）。
没有足够的证据就任何干预措施对百日咳咳嗽的影响得出结论。
