A patient walks into a doctor’s office with a cough and leaves with prescription for an antibiotic.
Mark Ebell sees something wrong with this picture.
“Of people who come in and complain of a new cough, about three out of four are given an antibiotic, and about half of those are a broad-spectrum antibiotic, yet only about 1 in 10 has a bacterial infection that can potentially benefit from an antibiotic,” said Ebell, a physician and researcher at the University of Georgia College of Public Health.
Despite numerous warnings about the long-term dangers of overprescribing antibiotics, many health care providers still recommend antibiotics for patients with a cough who don’t need them, and part of the reason for that, Ebell said, is doctors don’t have good tools to sort out when to prescribe an antibiotic.
Now, Ebell and collaborators at Georgetown University and the University of Wisconsin have received a five-year, $2.4 million grant from the Agency for Healthcare Research and Quality to help physicians and patients reduce inappropriate antibiotic prescribing.
The study, which is the largest of its kind in the U.S., will gather clinical data for 1,400 patients who present with an acute cough and track their progress over the length of their illness.
“Family physicians, emergency physicians and other primary care providers see a lot of acute respiratory infections,” said Ebell.
Much to learn
In fact, nearly 40 million people every year see the doctor because they have a lower respiratory tract infection – cough, the flu or even pneumonia – yet there is still a lot we don’t know about these infections.
“What causes these infections, how long do they last, how can we distinguish ones that may benefit from an antibiotic from ones that don’t need an antibiotic, how can we more efficiently figure out who needs a chest X-ray – all these questions have not been well-studied in the U.S. primary care setting,” said Ebell.
The researchers plan to gather baseline data about each patient regarding demographic information, signs and symptoms, as well as lab tests, including a panel that looks for over 20 viruses and bacteria.
Based on how participants’ illnesses progress, the team will be able to better understand how patients with different acute lower respiratory tract infections present and how they progress.
“We hope to use all of that information to develop tools that can help doctors do a better job of figuring out who needs an antibiotic and who doesn’t,” he said.
This isn’t the first time Ebell has taken aim at curbing inappropriate antibiotic use. In a recent study that appeared in the Annals of Family Medicine, Ebell presented a series of simple clinical rules to accurately detect bacterial sinus infections.
Though primary practice guidelines only recommend the use of antibiotics for patients who have experienced prolonged or severe symptoms, an estimated 72 percent of patients with respiratory infections receive an antibiotic.
That number, Ebell said, has remained steady over the last few years, and a recent article in the Journal of the American Medical Association found that urgent care settings are even more likely to prescribe an unnecessary antibiotic.
“And that’s where a lot of people are getting their care now for this kind of infection, so we’ll be recruiting patients in urgent care centers to try to understand how we can help that population as well.”
The team began the first phases of the study in June 2018 and will begin recruiting patients in the summer of 2019.