Help-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study

Abstract

Acute cough is a common reason to prescribe antibiotics in primary care. This study aimed to explore help-seeking and antibiotic prescribing for acute cough in Chinese primary care population. This is a prospective multicentre observational study that included adults presenting with acute cough. Clinicians recorded patients’ presenting symptoms, examination findings and medication prescription. Patients completed symptom diaries for up to 28 days by charting their symptom severity and recovery. Adjusted binary logistic regression models identified factors independently associated with antibiotic prescription. Primary care clinicians (n=19) recruited 455 patients. A total of 321 patients (70.5%) returned their completed symptom diaries. Concern about illness severity (41.6%) and obtaining a prescription for symptomatic medications (45.9%), rather than obtaining a prescription for antibiotics, were the main reasons for consulting. Antibiotics were prescribed for 6.8% (n=31) of patients, of which amoxicillin was the most common antimicrobial prescribed (61.3%), as it was associated with clinicians’ perception of benefit from antibiotic treatment (odds ratio (OR): 25.9, 95% confidence interval (CI): 6.7–101.1), patients’ expectation for antibiotics (OR: 5.1, 95% CI: 1.7–11.6), anticipation (OR: 5.1, 95% CI: 1.6–15.0) and request for antibiotics (OR 15.7, 95% CI: 5.0–49.4), as well as the severity of respiratory symptoms (cough, sputum, short of breath and wheeze OR: 2.7–3.7, all P<0.05). There was a significant difference in antibiotic prescription rates between private primary care clinicians and public primary care clinicians (17.4 vs 1.6%, P=0.00). Symptomatic medication was prescribed in 98.0% of patients. Mean recovery was 9 days for cough and 10 days for all symptoms, which was not significantly associated with antibiotic treatment. Although overall antibiotic-prescribing rates were low, there was a higher rate of antibiotic prescribing among private primary care clinicians, which warrants further exploration and scope for education and intervention.

Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review

“…GPs and other primary care doctors are more likely to prescribe antibiotics to patients who expect them or whom they believe expect them [ 36 , 40 , 41 , 43 , 44 , 46 – 56 ]. This experience is replicated with other non-medical PCPs [ 44 ].…”

“…Measurement of patient expectation for antibiotic treatment for ARTI varies from 74% [ 58 , 59 ] to 10% [ 41 ], with many measurements in between [ 60 – 64 ]. The study showing 10% patient expectation for antibiotics was conducted in China among patients presenting with ARTI symptoms and found that concern about illness severity and obtaining symptomatic treatment were the main reasons for consulting with ARTI rather than obtaining antibiotics [ 41 ]. The two studies showing the highest patient expectation rates were both studies of parents’ attitudes to antibiotic prescribing for their children who were not sick at the time, and were based in Greece and Palestine.…”

“…The two studies showing the highest patient expectation rates were both studies of parents’ attitudes to antibiotic prescribing for their children who were not sick at the time, and were based in Greece and Palestine. Patient satisfaction varies with antibiotic prescription policies for ARTI and patients were less satisfied in practices with low antibiotic prescribing rates, and a cautious approach to antibiotic prescribing may require a trade-off in terms of patient satisfaction [ 41 , 65 ]. Patients were also less satisfied when they expected but were not prescribed antibiotics [ 48 , 66 , 67 ].…”

“…Large variations in antibiotic prescribing for URTI exist and are difficult to explain [ 22 , 35 ]. Some potential explanations include the fact that many general practitioners (GPs) do not think that antibiotic prescribing in primary care is responsible for the development of antibiotic resistance [ 36 – 40 ] and, on average, acute cough can last from nine [ 41 ] to 18 days [ 42 ], while public expectation is for a duration of 7–9 days [ 42 ].…”

Patterns of medication use and factors associated with antibiotic use among adult fever patients at Singapore primary care clinics

“…Prescribing clinicians may perceive these as risk factors for more severe or longer-lasting illness, or secondary infection [18–20], and may be more likely to prescribe antibiotics to these patients [6, 21]. …”