In a time when antibiotic resistance poses a significant threat to global health, a new perspective on the management of acute cough in outpatients is desperately needed. In a letter to the editor of the journal ‘Chest’, titled “Outpatients With Acute Cough: Urgent Need to Implement Streamlining of Antibiotic and Antiviral Treatments,” Dr. Mathieu Blot and colleagues highlight this urgent health care issue and discuss the need for more prudent use of antibiotic and antiviral medications. This letter, published in May 2019 (Chest, Volume 155, Issue 5, Pages 1081-1082, DOI: 10.1016/j.chest.2018.11.031), emphasizes that there is an overprescription of these treatments for acute cough, despite the often viral cause, which antibiotics don’t affect.
Acute cough, a common symptom that leads patients to seek medical attention, is generally caused by respiratory infections, most frequently of viral origin, such as influenza or common cold viruses. Antibiotics, which are designed to combat bacterial infections, are not only ineffective against viruses but their overuse also contributes to the development of antibiotic-resistant bacteria, a problem that the World Health Organization has deemed one of today’s biggest threats to global health.
The letter, authored by Dr. Blot, along with Philippe Bonniaud and Lionel Piroth from the François Mitterrand Teaching Hospital in Dijon, France, comments on a study published in an earlier issue of ‘Chest’ (DOI: 10.1016/j.chest.2018.11.031), which delved into optimized treatment strategies for outpatients presenting with acute cough. Blot and colleagues contend that even with clear clinical evidence and recommendations to reduce the misuse of antibiotics and antivirals, implementation in real-world clinical practice remains lackluster.
The study in question (Chest, 2019 Jan;155(1):155-167) had already highlighted the point that antibiotics are overly prescribed for acute cough, even when clinical guidelines suggest otherwise. The follow-up letter by Dr. Blot et al. reiterates the same concerns and points out the lack of adherence to these guided strategies. They also addressed a subsequent response (Chest, 2019 May;155(5):1082-1083) to underline the continuous pattern of prescribing broad-spectrum antibiotics for uncomplicated acute cough, possibly leading to an increase in multidrug-resistant bacteria.
This emphasis on tackling the misuse of antibiotics and antivirals is supported by several studies, including systematic reviews and clinical practice guidelines, which recommend against routine prescribing of antibiotics for most cases of acute cough due to their minimal effect on improving symptoms and the potential for adverse reactions. Despite these clear guidelines, there is an evident discrepancy between the ideal practice and the real-world scenario.
The reasons for this overprescribing are multifaceted. There is the patient expectation for antibiotics, often fueled by a lack of understanding of their appropriate use, as well as the physician’s desire to meet patient expectations or concerns over missing a potentially serious bacterial infection without sufficient diagnostic tools to differentiate between bacterial and viral etiologies accurately.
To combat this problem, Blot and colleagues suggest that there is an urgent need for educational initiatives directed at both healthcare providers and patients. They call for the implementation of effective diagnostic support tools, like rapid point-of-care tests for determining the viral or bacterial cause of respiratory infections.
Moreover, public health campaigns and guidelines must do a better job of informing the public about the dangers of antibiotic resistance and the proper role of these drugs in treatment regimens. By implementing these measures, fewer patients will expect and receive unnecessary prescriptions for antibiotics when presenting with an acute cough, and there will be a greater emphasis on symptom relief and watchful waiting.
The commentary by Dr. Blot and his team serves as an urgent call to action to address this public health concern effectively. The overuse of antibiotics and antivirals is not a minor issue—it has significant implications for the effectiveness of these drugs in the future and for the overall health of the global population.
For healthcare providers and systems, the paper suggests that a multi-disciplinary approach is needed to rationalize the prescription of these treatments. This can include clinical decision support systems, better access to and use of diagnostic testing, more robust prescribing guidelines, and patient education programs. Additionally, there must be a consideration of the healthcare provider’s perspective, considering the challenges they face in differentiating bacterial from viral infections within the constraints of a busy clinical practice.
Implementing these measures won’t be simple or fast, but it’s an essential step towards combating antibiotic resistance and ensuring that future generations have access to effective treatments for bacterial infections.
References
1. Blot, M., Bonniaud, P., & Piroth, L. (2019). Outpatients With Acute Cough: Urgent Need to Implement Streamlining of Antibiotic and Antiviral Treatments. Chest, 155(5), 1081-1082. DOI: 10.1016/j.chest.2018.11.031
2. World Health Organization. (n.d.). Antibiotic resistance. World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance
3. Chest. (2019 Jan;155(1):155-167). DOI: 10.1016/j.chest.2018.11.031
4. Chest. (2019 May;155(5):1082-1083). DOI: 10.1016/j.chest.2018.11.031
5. Centers for Disease Control and Prevention. (2018). Antibiotic Prescribing and Use. Retrieved from https://www.cdc.gov/antibiotic-use/
Keywords
1. Acute cough treatment
2. Antibiotic overuse
3. Antimicrobial resistance
4. Outpatient management
5. Antibiotic stewardship