Abstract
We investigated whether discoloured sputum and feeling unwell were associated with antibiotic prescription and benefit from antibiotic treatment for acute cough/lower respiratory tract infection (LTRI) in a prospective study of 3,402 adults in 13 countries.
A two-level model investigated the association between producing discoloured sputum or feeling generally unwell and an antibiotic prescription. A three-level model investigated the association between an antibiotic prescription and symptom resolution.
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 prescription was not associated with a greater rate or magnitude of symptom score resolution (as measured by a 13-item questionnaire completed by patients each day) among those who: produced yellow (coefficient 0.00; p = 0.68) or green (coefficient -0.01; p = 0.11) sputum; reported any of three categories of feeling unwell; or produced discoloured sputum and felt generally unwell (coefficient -0.01; p = 0.19).
Adults with acute cough/LRTI presenting in primary care settings with discoloured sputum were prescribed antibiotics more often compared to those not producing sputum. Sputum colour, alone or together with feeling generally unwell, was not associated with recovery or benefit from antibiotic treatment.
- Acute cough
- antibiotic resistance
- antibiotic treatment
- lower respiratory tract infection
- primary care sputum
Footnotes
For editorial comments see page 9.
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Support Statement
This study was funded by 6th Framework Programme of the European Commission (LSHM-CT-2005-518226). The South East Wales Trials Unit is funded by the Wales Office for Research and Development. The funders had no role in the design and conduct of the study, or the collection, management, analysis or interpretation of the data, or in the preparation, review or approval of this manuscript. C.C. Butler had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. He is the guarantor. A. Torres was supported by grant 2009 SGR 911 from Ciber de Enfermedades Respiratorias (Ciberes CB06/06/0028); the Ciberes is an initiative of the Instituto de Salud Carlos III.
Clinical Trial
This study is registered at ClinicalTrials.gov with identifier number NCT00353951.
Statement of Interest
Statements of interest for T. Schaberg, T. Verheij and A. Torres can be found at www.erj.ersjournals.com/site/misc/statements.xhtml
- Received August 20, 2010.
- Accepted January 9, 2011.
- ©ERS 2011
