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Antibiotics have no measurable impact on the severity or duration of cough due to acute lower respiratory tract infection (LRTI) among adults presenting to primary care or urgent care, according to a study published online April 15 in the Journal of General Internal Medicine.

Daniel J. Merenstein, M.D., from Georgetown University Medical Center in Washington, D.C., and colleagues evaluated the impact of antibiotic use on the duration and severity of LRTI. The analysis included 718 adult patients presenting to U.S. primary or urgent care sites with a chief complaint of cough and symptoms consistent with LRTI.

The researchers reported that 29 percent of presenting patients had an antibiotic prescribed at baseline, most commonly amoxicillin-clavulanate, azithromycin, doxycycline, and amoxicillin. In patients with viral, bacterial, or mixed infections, provision of an antibiotic had no effect on the duration or overall severity of cough. However, antibiotic receipt did cut the likelihood of a follow-up visit (14.1 versus 8.2 percent; adjusted odds ratio, 0.47). Patients receiving an antibiotic were also significantly more likely to receive a systemic corticosteroid (31.9 versus 4.5 percent) and an albuterol inhaler (22.7 versus 7.6 percent). Patients believed that an antibiotic would cut the duration of their illness by nearly four days.

“Patients had unrealistic expectations regarding the duration of LRTI and the effect of antibiotics which should be the target of antibiotic stewardship efforts,” the authors write.

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