Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection

Abstract

We investigated whether discoloured sputum and feeling unwell were associated with antibiotic prescription and benefit from antibiotic treatment for acute cough/lower respiratory tract infection (LTRI) in a prospective study of 3,402 adults in 13 countries.A two-level model investigated the association between producing discoloured sputum or feeling generally unwell and an antibiotic prescription. A three-level model investigated the association between an antibiotic prescription and symptom resolution.Patients producing discoloured sputum were prescribed antibiotics more frequently than those not producing sputum (OR 3.2, 95% CI 2.1-5.0), unlike those producing clear/white sputum (OR 0.95, 95% CI 0.61-1.48). Antibiotic prescription was not associated with a greater rate or magnitude of symptom score resolution (as measured by a 13-item questionnaire completed by patients each day) among those who: produced yellow (coefficient 0.00; p50.68) or green (coefficient -0.01; p50.11) sputum; reported any of three categories of feeling unwell; or produced discoloured sputum and felt generally unwell (coefficient -0.01; p50.19).Adults with acute cough/LRTI presenting in primary care settings with discoloured sputum were prescribed antibiotics more often compared to those not producing sputum. Sputum colour, alone or together with feeling generally unwell, was not associated with recovery or benefit from antibiotic treatment.

Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg

“…23 The current study shows that the public consider that a cough with coloured sputum is more likely to benefit from antibiotic treatment. However, evidence does not show clinically important increased benefit.…”

Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis of potential high-risk groups

“…This finding provides some evidence to back up GPs' tendency to prescribe for this group. 11,24 Although statistically significant, the confidence intervals were wide, and in the absence of benefit in other outcomes, the balance between benefit and harm is likely to be marginal and only a modest reduction in the median or interquartile range of symptom severity was observed. This finding must also be put in context with the observational evidence, which showed no benefit for those with coloured sputum.…”

Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections

“…Just over half of the included studies were from the United States (n ϭ 15) (11,20,21,24,26,28,30,31,33,(38)(39)(40)(45)(46)(47), with the remainder from Canada (n ϭ 3) (34,37,43), The Netherlands (n ϭ 2) (29,35), Germany (n ϭ 2) (23, 42), Italy (n ϭ 1) (27), the United Kingdom (n ϭ 1) (25), Belgium (n ϭ 1) (22), and a network of 13 European countries (n ϭ 3) (36,41,44). Eight of the U.S. studies used the NAMCS (National Ambulatory Medical Care Survey) or NHAMCS (National Hospital Ambulatory Medical Care Survey) data sets for their analyses (11,28,31,33,(38)(39)(40)46).…”