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Green or yellow phlegm? No need for antibiotics finds study

Kathleen Blanchard's picture

Results of a new study show most cases of acute cough don't require antibiotics. Cardiff University scientists find prescribing antibiotics for green or yellow phlegm has no effect on recovery, even though most physicians question patients about the color of their sputum.

Sputum color no indication of bacterial infection

Chris Butler and colleagues from Cardiff University's School of Medicine studied 3402 adult patients with acute cough, finding patients with colored sputum are frequently given antibiotics compared to those who cough white or clear phlegm.

They found no difference in severity of symptoms related to color of phlegm. Nor was there any difference in recovery time when antibiotics were prescribed. The findings suggest sputum color is no indication of bacterial infection.

Antibiotic for acute cough drives bacterial resistance

Butler says, "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.

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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."

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

The study, published in the European Respiratory Journal, included 14 primary care centers. The findings suggest patients and health care providers may be placing too much importance on evaluating the color of phlegm in cases of acute cough.

For most patients, coughing up green or yellow phlegm is not a sign that antibiotics should be prescribed. The authors suggest antibiotics for discolored sputum drives antibiotic resistance and exposes patients to unnecessary side effects.

European Respiratory Journal
"Antibiotic prescribing for discoloured sputum in acute cough/LRTI: doi: 10.1183/​09031936.00133910
C.C. Butler, M.J. Kelly, K. Hood, T. Schaberg, H. Melbye, M. Serra-Pratf, F. Blasi, P. Little, T. Verheij, S. Mölstad M. Godycki-Cwirko, P. Edwards, J. Almirall A. Torres, U-M. Rautakorpi, J. Nuttall, H. Goossens and S. Coenen