Antibiotic Prescribing for Cough Is Complex for Clinicians

New research suggests that diagnosing patients with acute cough and determining whether antibiotics are appropriate may be more complex than guidelines presume.

Although guidelines suggest that antibiotics be avoided for acute cough, they are still prescribed in 65% of US adults who visit their primary care provider with acute bronchitis. To understand why antibiotic prescribing has remained common despite these recommendations, the study, published online on August 19, 2013, in BMC Family Practice, analyzed diagnoses, diagnostic uncertainty, and antibiotic prescribing in primary care visits for acute cough. The analysis included 962 primary care practice visits by patients aged 18 to 64 years with a cough lasting up to 21 days from March 2011 through June 2012. The researchers classified diagnoses as antibiotic appropriate, meaning that some but not a majority of patients may require antibiotics, or nonantibiotic appropriate.

Antibiotics were prescribed in 22% of all visits. The medication was prescribed in 65% of antibiotic-appropriate visits and in 4% of nonantibiotic-appropriate visits. Clinicians were uncertain of their diagnoses in 16% of all visits and were more likely to be uncertain when prescribing antibiotics or when giving multiple diagnoses. At the same time, clinicians were more likely to prescribe antibiotics when diagnosing multiple conditions.

The authors suggest that efforts to reduce antibiotic prescribing should focus on the diagnosing and prescribing issues clinicians face.