Abstract
BackgroundAcute cough is a common problem in general practice and is often caused by a self-limiting, viral infection. Nonetheless, antibiotics are often prescribed in this situation, which may lead to unnecessary side effects and, even worse, the development of antibiotic resistant microorganisms worldwide. This study assessed the role of point-of-care C-reactive protein (CRP) testing and other predictors of antibiotic prescription in patients who present with acute cough in general practice.MethodsPatient characteristics, symptoms, signs, and laboratory and X-ray findings from 348 patients presenting to 39 general practitioners with acute cough, as well as the GPs themselves, were recorded by fourth-year medical students during their three-week clerkships in general practice. Patient and clinician characteristics of those prescribed and not-prescribed antibiotics were compared using a mixed-effects model.ResultsOf 315 patients included in the study, 22% were prescribed antibiotics. The two groups of patients, those prescribed antibiotics and those treated symptomatically, differed significantly in age, demand for antibiotics, days of cough, rhinitis, lung auscultation, haemoglobin level, white blood cell count, CRP level and the GP’s license to self-dispense antibiotics. After regression analysis, only the CRP level, the white blood cell count and the duration of the symptoms were statistically significant predictors of antibiotic prescription.ConclusionsThe antibiotic prescription rate of 22% in adult patients with acute cough in the Swiss primary care setting is low compared to other countries. GPs appear to use point-of-care CRP testing in addition to the duration of clinical symptoms to help them decide whether or not to prescribe antibiotics.
Highlights
Acute cough is a common problem in general practice and is often caused by a self-limiting, viral infection
The aim of the present study was to assess factors associated with the prescription of antibiotics in patients presenting with acute cough and to scrutinize the role of point-of-care full blood count (FBC), C-reactive protein (CRP) testing and the immediate access to chest X-rays
Study population We focused on a sample of consecutive adult patients seeing their General Practitioner (GP) because of a cough lasting less than 3 weeks
Summary
Acute cough is a common problem in general practice and is often caused by a self-limiting, viral infection. This study assessed the role of point-of-care C-reactive protein (CRP) testing and other predictors of antibiotic prescription in patients who present with acute cough in general practice. The worldwide overuse of antibiotics is one of the main reasons for the development of resistance [4,5]. The antibiotic prescription rate in patients with acute cough varies largely in different countries, from 15% [6] to 83% [4]. The following GP-related factors influence the prescription rate: the assumption that patients want antibiotics [14,15], more or less years in practice [15,16,17], and the license to self-dispense antibiotics [18]. Patients’ assumption that antibiotics help and the GPs’ fear of a devastating outcome are two more
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