title: Clinical and haematological predictors of antibiotic prescribing for acute cough in adults in Swiss practices--an observational study.
abstract: BACKGROUND
  Acute cough is a common problem in general practice and is often caused by a self-limiting, viral infection. Nonetheless, antibiotics are often prescribed in this situation, which may lead to unnecessary side effects and, even worse, the development of antibiotic resistant microorganisms worldwide. This study assessed the role of point-of-care C-reactive protein (CRP) testing and other predictors of antibiotic prescription in patients who present with acute cough in general practice.
  
  
  METHODS
  Patient characteristics, symptoms, signs, and laboratory and X-ray findings from 348 patients presenting to 39 general practitioners with acute cough, as well as the GPs themselves, were recorded by fourth-year medical students during their three-week clerkships in general practice. Patient and clinician characteristics of those prescribed and not-prescribed antibiotics were compared using a mixed-effects model.
  
  
  RESULTS
  Of 315 patients included in the study, 22% were prescribed antibiotics. The two groups of patients, those prescribed antibiotics and those treated symptomatically, differed significantly in age, demand for antibiotics, days of cough, rhinitis, lung auscultation, haemoglobin level, white blood cell count, CRP level and the GP's license to self-dispense antibiotics. After regression analysis, only the CRP level, the white blood cell count and the duration of the symptoms were statistically significant predictors of antibiotic prescription.
  
  
  CONCLUSIONS
  The antibiotic prescription rate of 22% in adult patients with acute cough in the Swiss primary care setting is low compared to other countries. GPs appear to use point-of-care CRP testing in addition to the duration of clinical symptoms to help them decide whether or not to prescribe antibiotics.
authors: Institute of General Practice of the University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland. sven.streit@biham.unibe.ch.
authors: Sven
authors: S
authors: Streit
authors: Institute of General Practice of the University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland. peter.frey@biham.unibe.ch.
authors: Peter
authors: P
authors: Frey
authors: Institute of General Practice of the University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland. h.regnis@gmail.com.
authors: Sarah
authors: S
authors: Singer
authors: Institute of General Practice of the University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland. u.bollag@bluewin.ch.
authors: Ueli
authors: U
authors: Bollag
authors: Institute of General Practice of the University of Bern, Gesellschaftsstrasse 49, 3012, Bern, Switzerland. damian.meli@biham.unibe.ch.
authors: Damian N
authors: DN
authors: Meli
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis*; D003371:Cough / Q000188:drug therapy*; D003657:Decision Making; D058006:General Practice; D058005:General Practitioners; D006801:Humans; D007958:Leukocyte Count; D016015:Logistic Models; D008875:Middle Aged; D000067716:Point-of-Care Testing; D010818:Practice Patterns, Physicians'; D013557:Switzerland
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
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