title: Are smokers with acute cough in primary care prescribed antibiotics more often, and to what benefit? An observational study in 13 European countries.
abstract: Little is known about actual clinical practice regarding management of smokers compared with ex-smokers and nonsmokers presenting with acute cough in primary care, and whether a lower threshold for prescribing antibiotics benefits smokers. This was a multicentre 13-country European prospective observational study of primary care clinician management of acute cough in consecutive immunocompetent adults presenting with an acute cough of <or=28 days duration. There was complete smoking status data for 2,549 out of 3,402 participants. 28% were smokers, 24% ex-smokers and 48% nonsmokers. Smokers and ex-smokers had more chronic respiratory conditions (18.5% and 20.5% versus 12.5%). Median symptom severity scores were similar. Smokers were prescribed antibiotics more frequently (60%) than ex-smokers (51%) and nonsmokers (53%). After adjusting for clinical presentation and patient characteristics, the odds ratio of being prescribed antibiotics for smokers compared with nonsmokers was 1.44 (95% CI 1.12-1.86; p = 0.005). Patient recovery was not significantly different for smokers and nonsmokers, after adjusting for clinical presentation and patient characteristics. Smoking status was used as an independent factor to determine whether or not to prescribe an antibiotic. Being prescribed an antibiotic was not associated with recovery in smokers.
authors.affiliation: Dept of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK. stantonn@cf.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Stanton
authors.forename: K
authors.initials: K
authors.lastname: Hood
authors.forename: M J
authors.initials: MJ
authors.lastname: Kelly
authors.forename: J
authors.initials: J
authors.lastname: Nuttall
authors.forename: D
authors.initials: D
authors.lastname: Gillespie
authors.forename: T
authors.initials: T
authors.lastname: Verheij
authors.forename: P
authors.initials: P
authors.lastname: Little
authors.forename: M
authors.initials: M
authors.lastname: Godycki-Cwirko
authors.forename: H
authors.initials: H
authors.lastname: Goossens
authors.forename: C C
authors.initials: CC
authors.lastname: Butler
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003371:Cough / Q000188:drug therapy / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology*; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents