Cough and cold care kits reduce antibiotic use

A program in health clinics where physicians offer patients a cough and cold care kit containing over the counter medicines appears to significantly reduce unnecessary antibiotic use. Researchers from the Minnesota Antibiotic Resistance Collaborative (MARC) report their findings today at the International Conference on Emerging Infectious Diseases.

“Providing cough and cold care kits does appear to be a useful tool to use with patients who have upper respiratory illness or acute bronchitis to decrease unnecessary antibiotic use,” says Pamala Gahr of the Minnesota Department of Health, a researcher on the study.

The kits were initially produced by three local health plans that began distributing through their clinics during the 2000-2001 winter season. They consist of a colorful box filled with pain relievers, decongestant, cough syrup, lozenges, a packet of powdered chicken soup and a teabag. The following year 6 local health plans distributed approximately 31,000 kits.

“MARC was interested in a cost-benefit analysis,” says Gahr. “The health plans were spending a lot of money on these kits and were wondering if they were having any effect.”

Gahr and her colleagues compared the percentage of patients with upper respiratory illnesses or acute bronchitis who filled prescriptions for antibiotics after visiting clinics that distributed the kits with those that visited clinics that did not. Patients who visited clinics where the kits were distributed were significantly less likely to fill a prescription for antibiotics within 3 days of their visit.

“The inappropriate use of antibiotics to treat viral illnesses is thought to be a key factor in the rise of antibiotic-resistant bacteria,” says Gahr. Upper respiratory illnesses and acute bronchitis are generally caused by viral infections and antibiotics, which only work on bacteria, are not proper treatment. Usually, the best course of action in these cases is to treat the symptoms with rest and over-the-counter medication.

“In addition to the study data, we have had a lot of anecdotal feedback from physicians that it was a great idea to have something to give patients when you know they don’t need antibiotics. Patients come into these clinics, make their co-payments and feel like they should be getting something from their doctor,” says Gahr. “It validates the fact that yes, you feel crummy; yes you feel sick. You leave feeling satisfied.”

While the finding may be statistically significant, Gahr warns that the study size was limited. Further study with a larger sample is warranted.

The Minnesota Antibiotic Resistance Collaborative is working in conjunction with the Centers for Disease Control and Prevention’s “Get Smart: Know When Antibiotics Work” public education campaign to help reduce inappropriate antibiotic use.

The International Conference on Emerging Infectious Diseases is organized by the Centers for Disease Control and Prevention (CDC), the American Society for Microbiology, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories and the World Health Organization. More information on the meeting can be found online at www.iceid.org.