The majority of adults with a short duration of cough from an acute respiratory tract infection have a viral rather than a bacterial infection. Patients often underestimate the typical cough duration from an infectious illness, and when cough does not resolve within their expected time frame, may request antibiotics. The average duration of cough (not treated with antibiotics) is around 18 days, though patients only expect to cough for 5 to 7 days. Use of immediate or delayed antibiotics does not change clinical outcomes compared to no antibiotics in these situations. On the other hand, the harms of over-prescribing antibiotics include medication costs, adverse reactions, and the possibility of inducing bacterial resistance to antibiotics. Physicians should educate patients about the expected duration of cough and the consequences of inappropriate antibiotic use in acute respiratory tract infections.

Conditions: Cough, bacterial pneumonia, viral cough, antibiotics resistance

Treatments: Antibiotics

Sources

• Ebell MH, et al. How long does a cough last? Comparing patients' expectations with data from a systematic review of the literature. Ann Fam Med. 2013 Jan-Feb;11(1):5-13. (PubMed)
• McNulty CA, et al. Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg. Br J Gen Pract. 2013 Jul;63(612):e429-36. (PubMed)
• Smith SM, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014 Mar 1;(3):CD000245. (PubMed)
• Snow V, et al. Principles of appropriate antibiotic use for treatment of acute bronchitis in adults. Ann Intern Med. 2001 Mar 20;134(6):518-20. (PubMed)
• Spurling GK, et al. Delayed antibiotics for respiratory infections. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD004417. (PubMed)