January 23, 2013
Unaware of Course of Illness, Patients Seek Antibiotics Too Early in Acute Bronchitis

Athens, GA—Pharmacists may be able to play a role in reducing unnecessary antibiotic prescribing by sharing one piece of critical information with customers suffering acute bronchitis: Their cough will last an average of 17.8 days, not the 7 to 9 days they probably expect.

That’s according to research from the University of Georgia, which found that the difference in the length of time patients expect an acute cough illness to last and the reality of the situation can vary by more than a week. The study, which points out that a bronchial illness often takes around 18 days to run its course, was published recently in the Annals of Family Medicine.

“There is a mismatch in what people believe and reality,” said lead author Mark Ebell, MD, associate professor of epidemiology in the UGA College of Public Health. “If someone gets acute bronchitis and isn't better after four to five days, they may think they need to see a doctor and get an antibiotic. And when the first one doesn't work, they come back four or five days later for another.”

Ebell performed a meta-analysis of 19 observational studies, which included between 23 and 1,230 patients and took place in the United States, Europe, Russia, and Kenya. Untreated control groups were used to determine that acute cough illness actually lasts an average of 17.8 days.

Expectations of acute bronchitis’ duration were determined through the bi-annual Georgia Poll, a random digit dialing survey of 500 Georgia residents from the UGA Survey Research Center. On average, respondents said they expected the illness to last 7 to 9 days.

Patients expecting a longer duration of illness were more likely to be white, female, and have self-reported asthma or lung disease, according to the research, while those who were of nonwhite race, reported some college education or less, and had previously taken antibiotics for acute cough were more likely to believe antibiotics are always helpful in that situation.

Complicating the matter, the authors note, is that patients who take an antibiotic 7 days after the onset of symptoms may feel better 3 or 4 days later, with full resolution 10 days later. That can reinforce the mistaken belief that the antibiotic was effective, while, actually, the natural course of the illness was playing out.

Ebell, who said he first noticed the gap between expectations and realities while working as a family practice physician, noted that acute cough illness accounts for 2% to 3% of visits to outpatient physicians, and, in more than half of the cases, patients leave with a prescription for antibiotics, according to statistics from the CDC.

“We know from clinical trials there is very little, if any, benefit to antibiotic treatments for acute cough because most of these illnesses are caused by a virus,” he said. “Among patients who receive antibiotics, about half of those will be very broad spectrum antibiotics that have the potential to increase antibiotic resistance. These are antibiotics that would be nice to still have around when we actually need them, like for someone who may have pneumonia.”

In addition to antibiotic resistance, health care costs are a factor to consider, Ebell said, noting that over-the-counter cough medicine and pain relievers can be purchased for less than $20 compared to the much higher costs of a doctor’s visit.

Ebell recommends that health care professionals educate patients about the natural progression of illnesses and said he is creating a web portal to advise patients on when they need to seek medical attention.

U.S. Pharmacist Social Connect