Retrospective treatment outcome study of treatment seeking for cough in China

Problem

This online survey aimed to explore treatment-seeking behaviour for cough in China. In particular, it aimed to identify the patterns of participants’ use of antibiotics, modern medicine, Chinese herbal medicine (CHM), and other treatments for cough; to identify which commonly used treatments for cough are associated with the best outcomes in the Chinese population; and to examine whether the use of some patented CHM is associated with a reduction in antibiotic use.

Approach

Potential participants were recruited through a social media platform (WeChat) with a QR code to the online survey developed using Wen Juan Xing survey. Retrospective clinical information was collected on patients who: either were experiencing or had experienced cough in the last 6 weeks; had taken oral medicines (modern medicine or CHM, either self-care or given by health care professionals), or non-medical approaches to help with the cough. The survey contained key questions on participants’ sociodemographics and basic lifestyle information on smoking; and key questions such as:• What treatment(s) did you/ the patient use for the last episode of cough? • What was the progress (cured/better, same/worse)?• How much did each treatment help with the cough symptom?• Did you / the patient take antibiotics during the course of cough?• Have you / the patient experienced any adverse events during your course of treatment?

Findings

The survey was circulated with data collection between January and February in 2019. 26756 participants were recruited, among which 25597 (95.7%) experienced acute cough with an average severity score of 5.34 on a 0-10 numerical rating scale. Only a small minority had any symptoms of lower respiratory tract infections and most had symptoms of upper respiratory tract infections.Of these participants, 45.3% used antibiotics, 39.4% used Chinese herbal medicine, 27.1% used non-antibiotic medications, and 20.9% used non-medical interventions. The top five antibiotics used were Amoxicillin, Ceftizoxime, Ampicillin, Cefoxitin and Cefuroxime. Only about 50% actually took antibiotics following recommendation from a doctor. Near half of the participants got their antibiotics from a drug shop (49.4%), followed by public community health centre 32.0%, traditional Chinese medicine hospital 27.1%. 4140/10074 (41.1%) participants had subsequently used antibiotics after taking CHM, while 4730/6947 (68%) after taking non-antibiotic medications.

Consequences

Although a series of antimicrobial stewardship guidelines and policies have been released in China since 2011, there was a high level of antibiotic use in acute cough, which in the majority of cases was probably unnecessary and potentially harmful. CHM may be a potential way of reducing the use of antibiotics in acute cough and our findings identified a few promising remedies worth further exploration on their effects and safety. A large number of patients seek antibiotics from easily accessible drug shop which is often less strictly regulated and may provide inadequate quality of care. There is a need to regulate drug shop practices of prescribing and selling antibiotics.