Most coughs can be effectively managed with basic home remedies instead of antibiotics. A recent study found that in healthy adults with acute bronchitis, antibiotics did not help alleviate the cough or speed up its resolution.
Key Points to Note:
- Cough is the most frequent reason people visit the doctor for an illness.
- Most coughs are viral in nature and cannot be treated with antibiotics.
- Even when a bacterial infection causes the cough, antibiotics won’t reduce its duration or severity.
Using antibiotics to treat acute bronchitis did not alleviate the severity or duration of a cough, regardless of whether the cough was due to a bacterial or viral infection, according to a study published on April 15 in the Journal of General Internal Medicine.
This research reinforces the existing guidelines, which advise against prescribing antibiotics to individuals with acute bronchitis who are otherwise healthy and not at high risk for serious complications, says Jennifer Pisano, MD, an associate professor of medicine at UChicago Medicine and the medical director of the Antimicrobial Stewardship and Infection Control program.
“This study should help providers feel confident in following the guidelines, even in the small percentage of bronchitis cases caused by bacteria,” Dr. Pisano, who was not part of the study, said.
Cough: The Number One Culprit Behind a Doctor’s Visit
According to lead author Dan Merenstein, MD, a professor of family medicine at Georgetown University School of Medicine in Washington, DC, cough is the most common illness-related reason for visiting a doctor. It leads to nearly three million outpatient visits and over four million emergency department visits each year, as stated in a press release.
“Upper-respiratory tract infections usually include the common cold, sore throat, sinus infections, and ear infections, and have well-established ways to determine if antibiotics should be given,” Dr. Merenstein said.
Colds, flu, most sore throats, and coughs are caused by viruses, which cannot be treated with antibiotics. In contrast, bacterial infections such as ear infections, certain sinus infections, urinary tract infections (UTIs), and strep throat can be treated with antibiotics. For these bacterial illnesses, doctors can identify whether antibiotics are necessary and which type to prescribe.
Around 30% With Cough Given an Antibiotic
This study examined individuals with lower-respiratory tract infections, also known as acute bronchitis, which impact the airways and typically result in a deep, persistent cough and fever.
Lower-respiratory tract infections can be more hazardous, as approximately 3 to 5 percent of these patients develop pneumonia, stated Merenstein. Pneumonia occurs when the infection spreads deeper into the lungs.
The observational study involved over 700 people aged 18 to 75 who visited their primary care doctor or urgent care between June 2019 and April 2023 with acute bronchitis. The average age was 39, and about 75 percent had a moderately severe cough or worse. Participants reported experiencing a cough for an average of five days before their doctor visit.
In total, 29 percent of patients received at least one antibiotic, all of which were appropriate and commonly used to treat bacterial infections. Additionally, 7.1 percent received an antiviral agent.
Severe Symptoms Were More Likely Required for an Antibiotic
Individuals prescribed an antibiotic were significantly more likely to exhibit moderate to severe cough, colored phlegm, nasal congestion or discharge, wheezing, and fatigue compared to those who did not receive one. Additionally, those experiencing a cough that led to shortness of breath, lightheadedness, nausea, or vomiting were also more likely to be given an antibiotic.
The severity of the cough was recorded at the beginning of the study and on days 3, 7, 14, 21, and 28 through a text-linked online survey.
Although patients expected that taking an antibiotic would shorten their cough duration by four days, the results revealed that those who were prescribed an antibiotic actually experienced their cough for an average of 1.5 days longer than those who did not receive an antibiotic (17.5 days versus 15.9 days).
This increase most likely didn’t have any relation to the antibiotics, but rather was “largely due to patients with a longer duration of illness prior to the index visit being more likely to receive an antibiotic,” the researchers wrote.
To accurately determine whether a bacterial or viral infection was present beyond the self-reported symptoms of a cough, the investigators used advanced lab tests to identify pathogens. These tests provided microbiologic results, classifying the presence of germs as only bacteria, only viruses, both virus and bacteria, or no harmful germs detected.
Antibiotics Were Found Not to be Helpful — Even Cough Caused by Bacteria
Even among the 40 individuals who tested positive for bacterial germs through PCR tests, the duration of their cough remained unchanged at 17 days, regardless of whether they received antibiotics.
Is it surprising that antibiotics didn’t alleviate the cough, even when caused by a bacterial infection? “The findings are a bit surprising, but perhaps they shouldn’t be,” Pisano remarked.
After all, she noted, most respiratory infections treated in primary care settings (outside hospitals) are managed without determining whether they are caused by a virus or bacteria.
“Providers, even though well intended, may prescribe antibiotics out of fear of missing a bacterial infection that could lead to a worse outcome based on older age or worse symptoms, and this study gives us data that should help decrease those fears,” Pisano stated.
Antibiotics might not alleviate symptoms of a bacterial infection because these symptoms could be more closely linked to the immune system’s response in combating the infection rather than being specific to the type of pathogen—be it bacterial or viral, she explains.
People at Higher Risk for Severe Disease May Require an Antibiotic for Acute Bronchitis
Adults with a robust immune system and healthy lung function can typically combat common viruses and bacteria responsible for lower respiratory tract infections. This resilience may explain why antibiotics did not alter the duration of symptoms or outcomes.
“It is important to note that anyone high-risk for severe illness was excluded,” she said.
Individuals at higher risk, such as those with compromised immune systems or reduced lung function, may require antibiotics for such infections. Paul Pottinger, MD, an infectious disease specialist at UW Medicine in Seattle, who was not part of this study, emphasizes that their primary care provider would determine the necessity of antibiotics in these cases.
Instead of prescribing antibiotics to healthy adults, healthcare providers should assist patients in understanding the expected timeline for recovery from lower respiratory tract infections.
“That may increase a patient’s confidence that what they are experiencing is expected and does not require treatment with antibiotics,” Pisano said.
Why You Shouldn’t Just Take Antibiotics
Dr. Pottinger advises against unnecessary antibiotic use for several reasons. Similar to any medication, antibiotics can induce side effects such as nausea, diarrhea, and allergic reactions. Moreover, research indicates that antibiotics can disrupt gut health and diminish microbiome diversity.
An equally critical issue linked to antibiotic overuse is resistance. The World Health Organization identifies antimicrobial resistance as a paramount global health challenge, contributing significantly to mortality worldwide.
Prevention of Infection May Be the Best Medicine
Dr. Pottinger provides practical advice on preventing these infections:
- If you smoke or vape, discuss cessation strategies with your healthcare provider. According to Pottinger, both smoking and vaping significantly increase the risk of such infections.
- Keep your immunizations current. Pottinger emphasizes that staying up to date with vaccinations is crucial for maintaining good health.
- Steer clear of individuals who are sick. “If you’re around someone who’s coughing, sneezing, everyone try to get away from them because those infections do tend to spread,” advises Pottinger.
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