title: Acute cough: the use of antibiotics and health care services in an urban health centre in Israel.
abstract: BACKGROUND
  Acute cough, often caused by a viral respiratory infection, is a common symptom in primary care. Although clinical guidelines recommend symptomatic treatment for acute cough, antibiotics are frequently prescribed.
  
  
  OBJECTIVE
  To determine antibiotic prescribing for acute cough at the initial consultation and to follow subsequent medical consultations and use of medications.
  
  
  METHODS
  The study population included all adult patients with acute cough who visited general practitioners from one health centre (HC) during four months. Information was gathered from medical charts and telephone interviews conducted two weeks later.
  
  
  RESULTS
  Fifty six of three hundred and thirty eight participants (16.6%) received antibiotics at the initial visit. Eighty three participants made subsequent visits to the HC, 40 participants visited physicians outside the HC and nine participants visited both. During two weeks after the initial visit, 35 participants were prescribed antibiotics (eight in the HC, 27 outside the HC). Total antibiotic use rose to 27% (91/338) during the study period. At that time 98 (29%) of the participants reported they were still ill. Multivariate analysis showed that expectation to receive antibiotics was reported at a higher rate by the participants who received it, as compared to those who did not (32.2% versus 13.2%, OR: 2.3; 95% CI: 1.2-4.8). Receiving antibiotics was also associated with use of health services (20.3% versus 9.9%, OR: 2.7; 95% CI: 1.2-6.2).
  
  
  CONCLUSIONS
  Patient activism during the course of acute cough is associated with increased antibiotic use.
authors.affiliation: Department of Family Medicine, Emek Medical Centre, Afula, Israel. eilat_s@netvision.net.il
authors.forename: Sophia
authors.initials: S
authors.lastname: Eilat-Tsanani
authors.forename: Hava
authors.initials: H
authors.lastname: Tabenkin
authors.forename: Bibiana
authors.initials: B
authors.lastname: Chazan
authors.forename: Idit
authors.initials: I
authors.lastname: Lavi
authors.forename: Shlomit
authors.initials: S
authors.lastname: Cwikel-Hamzany
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003371:Cough / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D058005:General Practitioners / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011446:Prospective Studies; D019037:Urban Health Services / Q000592:standards; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents