When a cough lasts more than a week most of us think we need an antibiotic. Experts from the University of Georgia explained that acute bronchitis (an acute illness with hacking cough) can last for weeks.
The authors explained in Annals of Family Medicine that an acute cough lasts for an average of 18 days. People’s concern that their cough has gone on for over a week is contributing to the over-prescription of antibiotics.
Dr. Mark Ebell and team set out to compare how long most coughs last and people’s expectations. They found that patients expect their cough to be resolved within one week to up to a maximum of nine days. In reality, a bronchial illness (which includes coughing) takes an average of 18 days to clear up.
The team gathered and examined data on 19 observational studies across Europe, the USA, Kenya and Russia. They found that by looking at the average time a cough took to run its course among those in the placebo groups (untreated control groups), a cough lasts for an average of 17.8 days.
They added targeted questions to the bi-annual Georgia Poll to determine how long patients usually expect their coughs to last. This poll is a random telephone dialing survey of 500 people in Georgia from the UGA Survey Research Center. They found that patients expect their cough to last from seven to nine days – much less time than coughs actually last for.
Dr. Ebell first noticed that people’s expectations of a normal cough’s duration were too short when he worked as a primary care physician (general practitioner, family doctor). “There is a mismatch in what people believe and reality. If someone gets acute bronchitis and isn’t better after four to five days, they may think they need to see a doctor and get an antibiotic. And when the first one doesn’t work, they come back four or five days later for another.”
Acute cough illnesses account for 2% to 3% of visits to outpatient doctors. Half of these patients come out of their visit with a prescription for antibiotics – that is far too many people, Ebell said. Antibiotics are ineffective against coughs caused by a cold virus.
According to the Centers for Disease Control and Prevention, acute cough illness accounts for two to three percent of visits to outpatient physicians. Over half of these patients leave with a prescription for antibiotics. Ebell said this percentage should be much lower.
If your cough persists for longer than 18 days and does not seem to ease up at all, you should check with your doctor. Very persistent coughs may be a sign of something more serious.
Overprescribing antibiotics for coughs contributes to antibiotic resistance
“We know from clinical trials there is very little, if any, benefit to antibiotic treatments for acute cough because most of these illnesses are caused by a virus. Among patients who receive antibiotics, about half of those will be very broad spectrum antibiotics that have the potential to increase antibiotic resistance. These are antibiotics that would be nice to still have around when we actually need them, like for someone who may have pneumonia.”
If patients are being prescribed antibiotics when they do not yet need them, there is a much greater risk of bacterial resistance. Bacterial resistance results in fewer medications a doctor can prescribe when his/her patient has a serious health threat.
Several types of infections are becoming much more difficult to treat because fewer and fewer antibiotics are effective. In some cases, none of them work properly. “It is a real concern among public health officials that we will get to a point where we don’t have antibiotics that work,” Ebell added.
Seeing the doctor too early about a cough raises health care costs
Going to see the doctor can raise the cost of a virus from $20 for an OTC (over-the-counter) cough medication and painkiller to over $200 for expensive prescriptions and diagnostic tests.
The authors said that healthcare spending is not a bottomless pit – resources are limited. In the USA, twice as much per person is spent on healthcare than in any other country, but Americans do not have better overall outcomes. In fact, when the USA is compared to Western Europe, outcomes are generally worse.
Americans spend too much healthcare money on things that have absolutely no impact on health. We have to determine what really does work, what doesn’t, and better target our resources, the authors wrote.
Patients need to be educated about the natural progression of acute coughs, as well as other illnesses, Ebell said, so that their expectations are realistic.
Dr. Ebell is currently working on a Web portal which advises visitors about their risk of certain illnesses. The portal has data which was gathered from the CDC (Centers for Disease Control and Prevention), local health departments, and family physicians. Patients input their symptoms and get some idea on whether they should seek medical attention. Ebell says that hopefully this will help improve self-care and prevent patients from seeking out unnecessary antibiotics.
Written by Christian Nordqvist
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