“Doctor, I have had this cough for a couple of weeks. I’d like an antibiotic to get rid of this bug.” How many times have physicians heard this lament?
The duration and severity of the cough as part of an upper respiratory condition has often been a determinant for the prescription of an antibiotic. Acute cough can be divided into infectious causes and noninfectious causes. In regard to the infectious causes of cough, the probability that the cough is part of a non-bacterial disorder is preponderant. In this situation, antibiotics would not provide any benefit. If a bacterial infection is suspected based on the patient’s signs, symptoms and clinical picture, the doctor may prescribe antibiotic therapy. With the recent reporting of the “super bug”, the Carbapenem-resistant Enterobacteriaceae or CRE, this warning should tame our cavalier use of the pen or computer to generate an antibiotic script.
As reported in the Internal Medicine News article “Gauging cough duration can stem antibiotic overuse”, the National Ambulatory Medical Survey in 2007 showed that 27 million outpatient visits for cough were reported that year. That constitutes 2%-3% of all family practice visits and half of patients received an antibiotic for their cough according to the authors. The patient expectation of how long the cough should last was 2 days to 1 week. According to major studies in patients with undifferentiated acute cough or bronchitis, the mean duration of the cough was 17-18 days with improvement at 14 days. Expecting the cough to be over in a week, the patients often request a prescription for an antibiotic or a better antibiotic if they have already been on an antibiotic.
To underscore the importance of judicious use of antibiotic therapy in the patient with symptoms of a cold, upper respiratory infection or acute bronchitis, HEDIS (Healthcare Effectiveness Data and Information Set) developed a measure under the heading Respiratory Conditions: Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis. The BCBSM PGIP (Physician Group Incentive Program) has incorporated Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis as one of 22 HEDIS measures that will be used for measuring performance under the Evidence-Based Care Initiative in 2013.
Appropriate treatment based on evidence-based guidelines and solid clinical judgment will provide population safety and positive patient outcomes.