There are wide variations in antibiotic prescribing throughout Europe. A new study shows that these have no influence on the rate of recovery from acute cough. It’s time to standardize antibiotic prescribing to protect us against antibiotic resistance.

Summary

Researchers looked at antibiotic prescribing for patients with an acute cough. There was wide variation in prescription rates between 13 European countries. And the pattern had no impact upon rates of recovery, suggesting a more rational approach to prescribing antibiotics is needed in order to prevent the spread of antibiotic resistance.

Introduction

Concern over pandemic flu is high and acute cough can be one of the symptoms. But a cough may also indicate a bacterial infection. Flu, being a viral infection, does not respond to antibiotics, but a bacterial upper respiratory infection will. It is important to look at how, when and why antibiotics are prescribed for cough – because inappropriate prescribing is a major factor in antibiotic resistance which could, in the future, render doctors powerless against serious bacterial infections. Indeed, many resistant strains have already emerged, highlighting the serious nature of this public health issue.

What was done

Researchers at the European Union Network of Excellence GRACE (www.grace-lrti.org) looked at the variation in antibiotic prescribing across Europe for acute cough and its impact on recovery. GRACE is a program designed specifically to combat antibiotic resistance in the community. A group of 3,402 adults with new or worsening cough, possibly linked to respiratory tract infection, was recruited from primary care research networks in 15 European countries. Patients recorded the severity of the symptoms for 28 days and the doctors’ antibiotic prescribing behavior was recorded.

What was found

Overall, 53% of patients received antibiotics, with rates ranging from 21% to nearly 90%. Patients in Slovakia, Italy, Hungary, Poland and Wales were at least twice as likely to be prescribed antibiotics than the overall average. Patients in Norway, Belgium and Sweden were at least four times less likely to be prescribed antibiotics than the average. The variation was not associated with any differences in patient recovery from the cough.

What this study means

This is the largest study of its kind and the researchers think that the findings suggest it is time for clinically relevant guidelines on management of acute cough. In particular, it should be realized that antibiotics should not be prescribed for cough unless there is a good clinical reason – the dangers of antibiotic resistance would usually be the more important consideration.

Source

Butler CC, Hood K et al Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries BMJ 2009; 338:b2242