nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Monday, March 28, 2011

Antibiotics For Cough And Phlegm

 
A European study says that patients who come in with a cough and phlegm from a "lower respiratory" illness don't do any better with antibiotics.

But medical practitioners typically give antibiotics for yellow or green phlegm.  The thinking has been that if there is a purulent (pus-like) phlegm then the disease is bacterial.  Ergo, you give antibiotics.  Many health care providers think that clear or white phlegm is due to allergy or viruses...for which antibiotics are useless, and if prescribed, risk adverse reactions.  For a news article, go here.

If I remember the research from decades ago, the theory that the character of the phlegm provides treatment guidance was shown to be false.  That is, coughing up a gross-looking phlegm could still be viral...or represent bacterial colonization that wasn't related to the illness.

However, it's not as easy (particularly in the US) to convince patients that without any treatment they are going to get well just as fast.  Psychologically, people want an "action taken," and it's hard to make the case that doing nothing is best.

The researchers say that the severity and duration of symptoms doesn't change when antibiotics are used.

For Onion Peelers,
Patients producing discoloured sputum were prescribed antibiotics more frequently than those not producing sputum (OR: 3.2, 95% CI: [2.1, 5.0]), unlike those producing clear/white sputum (OR: 0.95, 95% CI: [0.61,1.48]). Antibiotic prescribing was not associated with greater rate or magnitude of symptoms score resolution among those who: produced yellow (Coefficient: 0.00, p-value:  0.68) or green sputum (Coefficient: −0.01, p-value: 0.11); reported any of three categories of feeling unwell; produced discoloured sputum and felt generally unwell (Coefficient: −0.01, p-value: 0.19).


It's hard to tell how the patients were selected and the study abstract doesn't say what kind of "lower respiratory" diseases were present.  Clearly, some cases of severe pneumonia or chronic bronchitis require antibiotic treatment, or these patients could succumb.

So it's hard to validate their conclusion without access to the raw data and methods.  We haven't heard the end of this.

While we need to reduce unnecessary drug prescribing in this country, I don't think it's going to change providers' treatment preferences...or patient's expectations.

Doc D

 

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