There is a large mismatch between patients' expectations regarding the duration of an acute cough and the actual duration based on the best available evidence, and this disparity has important implications for unnecessary antibiotic prescribing.
A systematic review of the medical literature showed the mean duration of a cough is 17.8 days. When surveyed, nearly 500 adults in Georgia reported a median duration of only five to seven days and a mean duration of seven to nine days, depending on the specific scenario.
The researchers found patients expecting a longer duration of illness were more likely to be white, female and have self-reported asthma or lung disease. Those who were of nonwhite race (OR = 1.82), reported some college education or less (OR = 2.08), and had previously taken antibiotics for acute cough (OR =2.20) were more likely to believe antibiotics are always helpful for cough.
Addressing the important implications these findings have for antibiotic prescribing, the authors assert that if a patient expects an episode of cough should last about six to seven days, it makes sense they might seek care for antibiotics after five to six days. Furthermore, they posit, if they begin taking an antibiotic seven days after the onset of symptoms, they may begin to feel better three or four days later with the episode fully resolving 10 days later.
Although this outcome may reinforce the mistaken idea the antibiotic worked, it is merely a reflection of the natural history of acute cough. The authors conclude it is therefore important that physicians emphasize the natural history of acute cough with patients when they seek care for symptoms.
Moreover, if physicians themselves also underestimate the duration of acute cough, they may require continuing professional education to correct these beliefs.
Annals of Family Medicine: How Long Does a Cough Last? Comparing Patients' Expectations With Data From a Systematic Review of the Literature By Mark H. Ebell, MD, MS, et al University of Georgia, Athens