Treatment Patterns, Use of Cough Formulations, and Antibiotics in the Management of Acute Cough in Indian Adults and Elderly: A Real-world Study

Abstract

Background and objective: The management of acute cough has a range of treatment strategies, including prescription and nonprescription medicines, which may contain one or more active ingredients such as fixed-dose combinations (FDCs) and potentially the use of antibiotics. This study aims to analyze recommendation and prescription patterns for cough, focusing on the use and/or recommendation of antibiotics, and the single or FDCs of medicines.

Methodology: Electronic medical records (EMR) data from 2017 to 2023 of the patients of acute cough meeting the study criteria was retrieved and analyzed to understand the types of cough, its treatment pattern, and duration of treatment in Indian adults and elderly.

Results: Antibiotics were frequently prescribed for both the productive cough (adult: 60.33%, elderly: 62.01%) and nonproductive cough (adult: 53.13%, elderly: 52.27%), followed by various FDCs. Overall, dextromethorphan (productive 1.83%, nonproductive 4.37%) and levocloperastine (productive 1.61%, nonproductive 4.31%) were commonly used as monotherapy. Frequent prescriptions of antitussives for nonproductive cough as well as for productive cough were noted both in monotherapy (4.42%) and FDCs (21.84%). Among the antitussive FDCs used for productive cough, chlorpheniramine + dextromethorphan + phenylephrine (38.44%) was the most prescribed, followed by beta-agonists/bronchodilators (18.34%) and antihistamines (4.32%). Antibiotics were prescribed for both the productive (60.33%) and nonproductive (51.93%) cough. Azithromycin (19.10%, 20.65%) and cefpodoxime (5.61%, 6.44%) were the frequently prescribed antibiotic monotherapies for productive and nonproductive cough, respectively. Among the antibiotics, amoxicillin + clavulanic acid and cefpodoxime + clavulanic acid were the commonly prescribed FDCs. The duration of prescription of the cough medications was 3-5 days.

Conclusion: The study gives an overview of current cough management practices in India. The findings highlight the need for educating primary care physicians on the use of standardized guidelines and evidence-based management for common ailments like cough.