Acute cough: The use of antibiotics and health care services in an urban health centre in Israel

Background: Acute cough, often caused by a viral respiratory infection, is a common symptom in primary care. Although clinical guidelines recommend symptomatic treatment for acute cough, antibiotics are frequently prescribed. Objective: To determine antibiotic prescribing for acute cough at the initial consultation and to follow subsequent medical consultations and use of medications. Methods: The study population included all adult patients with acute cough who visited general practitioners from one health centre (HC) during four months. Information was gathered from medical charts and telephone interviews conducted two weeks later. Results: Fifty six of three hundred and thirty eight participants (16.6%) received antibiotics at the initial visit. Eighty three participants made subsequent visits to the HC, 40 participants visited physicians outside the HC and nine participants visited both. During two weeks after the initial visit, 35 participants were prescribed antibiotics (eight in the HC, 27 outside the HC). Total antibiotic use rose to 27% (91/338) during the study period. At that time 98 (29%) of the participants reported they were still ill. Multivariate analysis showed that expectation to receive antibiotics was reported at a higher rate by the participants who received it, as compared to those who did not (32.2% versus 13.2%, OR: 2.3; 95% CI: 1.2-4.8). Receiving antibiotics was also associated with use of health services (20.3% versus 9.9%, OR: 2.7; 95% CI: 1.2-6.2). Conclusions: Patient activism during the course of acute cough is associated with increased antibiotic use.