NCPA - National Center for Policy Analysis


July 15, 2005

Coming in third among the most common reasons to visit a doctor is the cough. In 2002, it represented 3.2 percent of all outpatient visits; 30 million were made for a chief complaint of cough and 10 million were made by otherwise healthy adults diagnosed with acute bronchitis, says Mark Ebell (Journal of the American Medical Association).

To alleviate the problem, patients are given an antibiotic that can cost between $50 and $100. But a JAMA study that surveyed 800 adults and children with a cough plus one symptom related to the lower respiratory tract found that antibiotic usage provides a small benefit:

  • Participants were randomly assigned to receive immediate antibiotics, no antibiotics or an offer of delayed antibiotics if symptoms had not resolved after 10 days.
  • The patients were typical of those diagnosed with acute bronchitis in primary care practice: two in three had a fever and more than 40 percent reported production of green sputum.
  • The results showed that there was no significant difference between patients receiving antibiotics and those receiving placebos.

What can a clinician gain from the study?

  • If the patient doesn't have pneumonia, antibiotics provide little or no benefit.
  • Physicians should inform patients that whether or not they take antibiotics, they can expect a cough to last about three weeks, and that for at least 25 percent of patients it will last nearly a month.
  • They should use the tactic of delayed prescriptions to mitigate the possibility of prescribing antibiotics in error.
  • They should also answer all of the patient?s questions and provide symptomatic care.

It is tempting to confuse more care with better quality care, says Ebell, but the primary goal of physicians should be to improve patient outcomes rather than improving satisfaction.

Source: Mark H. Ebell, "Antibiotic Prescribing for Cough and Symptoms of Respiratory Tract Infection," Journal of the American Medical Association, Vol. 293, No. 24, June 22/29, 2005; based upon: Paul Little et al., "Information Leaflet and Antibiotic Prescribing Strategies for Acute Lower Respiratory Tract Infection," Journal of the American Medical Association, Vol. 293, No. 24, June 22/29, 2005.

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