New metric for acute cough prognosis may help reduce antibiotic prescriptions

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Researchers recently tested a new metric for acute cough prognosis and determined whether it outperforms the former metrics.

An acute cough is an important symptom that brings many people to their primary care physicians. There are a reported to be about 30 to 50 patients for every 1000 patients per year in Europe experiencing acute cough, despite the various antibiotics present for the infections causing the cough.

Researchers suggest that when it comes to antibiotic prescriptions, health professionals should be aware of the complications that can occur on an individual basis. They note that it is important to weigh options carefully to justify the prescription of medications.

Metrics for the prognosis of acute cough

Metrics to measure the prognosis of patients with acute cough include the following:

  1. Pneumonia Severity Index (PSI)
  2. CRB (Confusion, respiratory rate, blood pressure)
  3. CURB (confusion, urea nitrogen, respiratory rate, blood pressure)
  4. CRB-65 (65 years of age and older)
  5. CURB-65

These metrics for diagnosing the prognosis of a patient considers adverse outcomes for inpatients and outpatients with their probability of dying from the lower respiratory infection. However, because the rate of death is so low, researcher Robin Bruyndonckx and team decided to develop a new metric to interpret the prognosis of acute cough.

Developing a new metric for prognosis

They collected data from 2604 adults within the network of Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe (GRACE). To be included in the study, the adults needed to have an acute cough or symptoms of a lower respiratory tract infection.

To measure the performance to predict poor outcomes in acute cough patients, the researchers compared the experimental metric with the existing prediction metrics. They also monitored improvements by checking additional tests such as C-reactive protein (CRP), blood urea nitrogen (BUN), and chest radiography. CRP is high in acute infection and inflammatory states, BUN checks the amount of protein being produced and excreted by the kidneys to maintain homeostasis in the body, and chest radiography visualizes the occurrence of any complications.

New prediction metric outperforms former metrics

The results published in the British Journal of General Practice demonstrated that the new prediction metric developed by these researchers could outperform all the former metrics, making it extremely useful for day-to-day prognosis made by health professionals for acute cough patients.

The importance of these results increased when the researchers were able to demonstrate that the added tests used to determine the outcomes of the patient were rendered insignificant against this prognostic metric system.

However, before healthcare practitioners can use this new metric in practice, further studies are needed to determine whether it can be used to improve patient management, such as avoiding adverse side effects. Nevertheless, this new metric may give general practitioners an advantage at analysing the real need to prescribe antibiotics for patients and reduce the amount of over-prescription.

Written by Dr. Apollina Sharma, MBBS, GradDip EXMD

Reference: Bruyndonckx, R., Hens, N., Verheij, T. J., Aerts, M., Ieven, M., Butler, C. C., … & GRACE project group. (2018). Development of a prediction tool for patients presenting with acute cough in primary care: a prognostic study spanning six European countries. Br J Gen Pract, bjgp18X695789.

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