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Cymraeg

When you cough up green or yellow phlegm you need to be prescribed antibiotics, right?

24 March 2011

Prescribing antibiotics for patients with discoloured phlegm caused by acute cough has little or no effect on alleviating symptoms and recovery, a Cardiff University study has found.

Acute cough is one of the common reasons why people visit their GP and accounts for a large proportion of antibiotics prescribed in the community. One of the most common questions asked by GPs to their patients is about their phlegm: "Are you coughing anything up?" or "What colour is your phlegm?"

Clinicians and patients commonly believe that yellow and green phlegm production is associated with a bacterial infection, which is more likely to benefit from antibiotic treatment compared to non-productive cough or cough that produces clear phlegm.

However, in a new study published in the European Respiratory Journal, Professor Chris Butler and his team from Cardiff University’s School of Medicine, together with colleagues from 14 European centres present data from an observational study of 3402 adult patients with acute cough presenting for health care in 14 primary care networks.

The research found that patients producing discoloured phlegm are prescribed antibiotics more frequently than those not producing phlegm unlike those producing clear/white phlegm.

Crucially, antibiotic treatment was not associated with greater rate or magnitude of symptoms score resolution among those who produced yellow or green phlegm. Neither was recovery among those feeling generally unwell on its own, or taken together with phlegm production, associated with antibiotic treatment.
Clinicians and patients are therefore likely to both be over interpreting the importance of the colour of phlegm in the decision whether or not to prescribe, or take, antibiotics.

Professor Butler, who led the study said: "One of the exciting things about this research is that our findings from this large, multi-country observational study resonate with findings from randomised trials where benefit from antibiotic treatment in those producing discoloured phlegm has been found to be marginal at best or non-existent.

"Our findings add weight to the message that acute cough in otherwise well adults is a self-limiting condition and antibiotic treatment does not speed recovery to any meaningful extent.

"In fact, antibiotic prescribing in this situation simply unnecessarily exposes people to side effects from antibiotics, undermines future self care, and drives up antibiotic resistance."

A single centre study, using different research methods, by one of Professor Butler’s predecessors at Cardiff University came to similar conclusions to this new research. Despite this, non-evidence based practice remains common across the UK.

-Ends-

Notes:

The study - Antibiotic prescribing for discoloured sputum in acute cough/LRTI. ERJ Express. Published on March 15, 2011 as doi: 10.1183/09031936.00133910, was published in the European Respiratory Journal. The paper can be viewed at:
http://erj.ersjournals.com/content/early/2011/03/10/09031936.00133910.abstract

Cardiff School of Medicine
Cardiff University’s School of Medicine is a significant contributor to healthcare in Wales, a major provider of professional staff for the National Health Service and an international centre of excellence for research delivering substantial health benefits locally and internationally. The school’s 800 staff include 500 research and academic staff who teach more than 2,000 students, including 1,110 postgraduate students.

The School is based at the Heath Park Campus, a site it shares the University Hospital of Wales, the third largest university hospital in the UK. The School has an all-Wales role, contributing greatly to promoting, enhancing and protecting the nation’s health. A key partner in this role is the National Health Service (NHS) in Wales, with which the School is linked at all levels. This mutual dependency is illustrated by the teaching of medical undergraduates in more than 150 hospitals located in all of Wales’ health authorities. The medical curriculum followed at the School enables students to acquire and apply knowledge, skills, judgement and attitudes appropriate to delivering a high standard of professional care. Around 300 new doctors currently graduate from the School every year and the Welsh Assembly Government has invested substantially in new teaching facilities to increase this number further.

The School is an international leader in basic and clinically applied research activities and scored highly in the most recent Government Research Assessment Exercise. School of Medicine researchers annually win tens of millions of pounds in research awards to work with Government, the healthcare industries and the charitable sector on the most pressing issues of human health. The School has six interdisciplinary research groups to draw upon its own strength in depth and the vast range of expertise available across Cardiff University. These groups are addressing cancer; health sciences research; cardiovascular sciences; genomic approaches to health and disease; infection, immunity and inflammation; metabolism repair and regeneration. The School continually invests in facilities, with major developments including the Henry Wellcome Building for Biomedical Research in Wales, the largest enterprise of its kind ever in Wales. This £11M centre contains research laboratories and facilities for patients to participate in investigations of new disease treatments.

The School has been instrumental in establishing and running many important national research initiatives including the Wales Gene Park, Wales Cancer Bank, the Cardiff Institute for Tissue Engineering and Repair and the Healing Foundation UK Centre for Burns Research. The Wales Gene Park is involved in biomedical research, the provision to the NHS of novel diagnostic and clinical services, knowledge dissemination, genetics and genetics education, and the successful commercialisation of innovations arising from such activities.

The Wales Cancer Bank is a collaborative project involving several Welsh NHS Trusts, the universities of Bangor and Swansea and the Welsh Assembly Government and is the first population-based collection of tumour and control tissue samples in Wales. The research will help establish the causes of cancer, help identify new areas for treatment and find out the best way to care for individual patients. The Cardiff Institute for Tissue Engineering and Repair uses scientific research to solve problems which are placing a heavy burden on health services around the world, such as, eye repair, chronic wounds, kidney repair and sports injuries. The Healing Foundation UK Centre for Burns Research is a multi-million pound collaboration investigating treatments and support for the physical and mental rehabilitation of the 14,000 people suffering severe burns in the country every year.

Cardiff University
Cardiff University is recognised in independent government assessments as one of Britain’s leading teaching and research universities and is a member of the Russell Group of the UK’s most research intensive universities. Among its academic staff are two Nobel Laureates, including the winner of the 2007 Nobel Prize for Medicine, University President Professor Sir Martin Evans.

Founded by Royal Charter in 1883, today the University combines impressive modern facilities and a dynamic approach to teaching and research. The University’s breadth of expertise in research and research-led teaching encompasses: the humanities; the natural, physical, health, life and social sciences; engineering and technology; preparation for a wide range of professions; and a longstanding commitment to lifelong learning. Three major new Research Institutes, offering radical new approaches to neurosciences and mental health, cancer stem cells and sustainable places were announced by the University in 2010.

Further information or to arrange an interview, please contact:

Angela Watkins
Support & Communication Officer
School of Medicine
Cardiff University
029 2087 190
WatkinsA6@cardiff.ac.uk