Abstract
Background
Uncomplicated episodes of prolonged acute cough are usually viral and self-limited,
but despite evidence and recommendations to the contrary, they are often treated with
antibiotics.
Methods
Mixed cross-sectional and prospective observational study of adults 18 years or older
presenting to two urgent care centers with a cough of 7 to 56 days as their chief
complaint. Factors associated with cough duration and clinical decisions were analyzed
by univariate and multivariate logistic regression.
Results
Of the 125 enrolled patients, 118 (94%) received an antibiotic, 97 (78%) a cough suppressant,
87 (70%) a systemic corticosteroid, and 39 (31%) a chest X-ray (CXR). Longer duration
of cough was associated with the presence of self-reported wheezing or noises (adjusted
odds ratio 6.29, 95% CI 1.36–29.16) while the presence of both wheezing and crackles
on a clinician chest exam was associated with shorter duration (aOR 0.03, 95% CI 0.00–0.27).
A clinician was more likely to order a CXR in patients with dyspnea (aOR 3.01, 95%
CI 1.21–7.49), less likely to prescribe a systemic corticosteroid in patients with
crackles (aOR 0.27, 95% CI 0.09–0.82), and more likely to prescribe a cough suppressant
to older patients (1.04 per additional year of age, 95% CI 1.01–1.07).
Conclusions
Systemic corticosteroids and cough suppressants are being prescribed at high rates
in patients with uncomplicated acute cough in the urgent care setting. Additional
studies to determine if similar rates are seen in other urgent care centers, or in
other contemporary ambulatory settings are warranted.
Keywords
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Article Info
Publication History
Published online: December 07, 2018
Accepted:
December 5,
2018
Received in revised form:
December 2,
2018
Received:
October 16,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
