Bad Cough for a Week? Don't Hightail it to the Doctor!

Around the last week of May, last year, I came down with some unnamed respiratory virus that mimicked the flu in almost every way except that I never had a fever. But I sure as hell had a hacking cough which my wife described as "sounding like the lungs were filled with fluid". Well, it got progressively worse over a period of ten-twelve days but I was determined not to run to my doc unless bloody stuff was coughed up or I could barely breathe. My concern was that if I went to the doctor I'd be prescribed amoxicillin or some other antibiotic, similar to what nearly killed my wife (with c. diff.) in 2006.

So I was determined to tough it out! Now, recent medical research news discloses that I did the right thing after all! According to a randomized trial published in  The Lancet Infectious Diseases there's little difference in the duration of lower-respiratory infections in people who took antibiotics and those who received placebos. Why? Respiratory illness manifesting as coughs, like flu,  are usually triggered by viruses—not bacteria—and thus are unaffected by antibiotics. Most often coughs and associated infections get better on their own.

In my case, it was roughly 16 1/2 days and the rasping cough had ended and I was out jogging and fast walking again! Was this too long? Hell no!

The authors of the Lancet study found that the average duration of symptoms reported in the medical literature was 17.8 days. That means my own cough distress ended more than a day earlier than the average duration.  The authors compared their findings to results from a poll of 500 adults,  asked to estimate how long they expected to be sick if their main symptom was a cough and they were not taking any medicine (under various scenarios with or without fever and with or without mucus). The polled sample said they expected the duration was about 7- 9  days. WRONG!

So, given their symptoms didn't end when they believed they should, these folks would have hightailed it to their doctors and asked for antibiotics, or would have been prescribed them by docs forseeing that patient expectation. So then, in another 3-4 days when their symptoms would have started alleviating they'd have wrongly attributed the outcome to the drugs when in fact it was the normal end of their illness.

This confirms for me why my decision not to jump the gun was the wise one.  As the authors of the Lancet article pointed out:

"This mismatch between patients’ expectations and reality for the natural history of acute cough illness has important implications for antibiotic prescribing,”

Well, yes, because then only in extreme circumstances should any doc worth his or her salt prescribe these drugs, which we are finding to be gradually become more useless as antibiotic-resistant strains of bacteria spread.   As the Lancet article authors put it:

"Patients should be told that it is normal to still be coughing two or even three weeks after onset, and that they should only seek care if they are worsening or if an alarm symptom, such as high fever, bloody or rusty sputum, or shortness of breath, occurs”

That's sound advice and I hope more people, especially in this flu season, also follow it. One thing is many more times dreadful than a "long" e.g. 2 1/2 week) cough, and that's getting c. diff.!