Coughing smokers get more antibiotics, to no avail

Doctors are more likely to prescribe antibiotics to treat cough in patients who smoke, but smokers get no more benefit from the drugs than non-smokers do, a large study from Europe shows.

People who smoke get more respiratory infections, and are more likely to develop pneumonia, Dr. Naomi Stanton of Cardiff University in Wales and her colleagues note. But the jury's out on whether chronic coughs last longer in smokers than in non-smokers, they add, and there is no evidence on whether smokers will get more benefit from antibiotic treatment for cough than smokers will.

At the same time, bacterial resistance to antibiotics is growing, fueled by at least in part by antibiotic overuse, and encouraging the appearance of bugs that doctors find it more and more difficult to treat.

Stanton and her team looked at more than 2,500 patients in 13 countries who had coughs lasting 28 days or less to investigate whether primary care providers would be more likely to prescribe antibiotics for smokers. Twenty-eight percent of the patients were smokers, 24 percent were ex-smokers and 48 percent had never smoked.

Smokers were more likely to have shortness of breath and wheezing than non-smokers, but symptoms were just as severe, on average, for ex-, non- and current smokers.

Doctors wrote antibiotic prescriptions for 60 percent of smokers, 53 percent of non-smokers, and 51 percent of ex-smokers.

Smokers were also more likely than non-smokers to think that antibiotics would help them if they had a cough lasting for longer than a few days.

Smokers who were prescribed antibiotics didn't recover any faster than those who didn't get the drugs; there also was no difference in the rate of recovery between smokers and non-smokers.

In each of the 13 countries studied, the researchers note, smokers were more likely to receive antibiotics to treat a cough. "This suggests that despite differences in training and practice setting, clinicians may have similar attitudes towards prescribing antibiotics for smokers," they conclude.

SOURCE: ERJ Express, online December 23, 2009.