title: Presentation, antibiotic management and associated outcome in Polish adults presenting with acute cough/LRTI.
abstract: OBJECTIVE
  In-depth knowledge of existing practice is required to inform interventions aimed at antibiotic prescribing quality improvement. We set out to describe the presentation, antimicrobial management and associated outcome of adults presenting in general practice with acute cough/lower respiratory tract infection (LRTI) in Poland.
  
  
  METHODS
  Observational study of 301 adults with acute cough/LRTI. Clinicians completed a case report form (CRF) describing presentation, history and management and patients completed a symptom diary for up to 28 days after consultation.
  
  
  RESULTS
  Two hundred and twenty-one patients (with CRF and symptom diary completed) were analysed. The median duration of feeling unwell before presentation was 4 days. Clinicians recorded an average of eight symptoms for patients at presentation. Apart from cough, patients most commonly reported feeling generally unwell (91.9%), limitation of normal activities (80.5%), coryza (80.1%) and phlegm production (76.0%). Auscultation abnormalities were present in 55.0%. Overall, medicines were prescribed for 95.0%; 72.4% were prescribed antibiotics [mostly macrolides/lincosamides (38.8%) and amoxicillin/co-amoxiclav (36.3%)) with 11.3% advised to take antibiotics only if still necessary after a specified delay. Mucolytics were prescribed for 61.1%. Antibiotic prescription was strongly associated with a diagnosis of LRTI and the presence of auscultation abnormalities. The median duration of cough after presentation was 8 days.
  
  
  CONCLUSIONS
  Antibiotics continue to be frequently prescribed for acute cough/LRTI in Poland, and the decision to prescribe was strongly associated with clinicians' findings of abnormalities on auscultation and diagnosis of LRTI. Delayed prescribing was infrequent. Mucolytics were commonly prescribed despite evidence of no effect.
authors.affiliation: Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland.
authors.forename: Maciek
authors.initials: M
authors.lastname: Godycki-Cwirko
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.forename: Marek
authors.initials: M
authors.lastname: Nocun
authors.forename: Magdalena
authors.initials: M
authors.lastname: Muras
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001314:Auscultation; D003371:Cough / Q000188:drug therapy / Q000209:etiology*; D011307:Drug Prescriptions; D005260:Female; D058006:General Practice; D006801:Humans; D055231:Lincosamides / Q000627:therapeutic use; D016015:Logistic Models; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011044:Poland; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D055231:Lincosamides; D018942:Macrolides; D019980:Amoxicillin-Potassium Clavulanate Combination