A recent study has exposed serious deficiencies in cough management in India, showing that most cases are improperly classified and often treated with irrelevant antibiotics. The findings, published in the Journal of the Association of Physicians of India, highlights the urgent need for a more scientific and evidence-based approach for cough treatment.
Why Cough Management in India Needs Improvement
- The study analysed electronic medical records of more than 22 lakh patients. It found that most cough cases were left unspecified—neither labelled as productive, non-productive, allergic, or otherwise. Among adults, over 71% of cases went uncategorised, while among elderly patients the number was 66%.
- Because of this poor classification, doctors often prescribed antibiotics even when they were not required. For example, more than half of the patients—whether their cough was productive or not—were given antibiotics.
- Around 60% of adults with productive cough and 52% with non-productive cough received antibiotics. Similar prescribing trends were seen among older patients as well.
How Misclassification Affects Treatment and Risks
The study highlighted that Azithromycin is the most frequently used antibiotic, followed by cefpodoxime, and that fixed-dose combinations like amoxicillin with clavulanic acid are also commonly prescribed.
Additionally, multi-ingredient cough syrups or formulations which may combine symptomatic relief with antibiotics are often used even when they are not clinically justified.
Such practices come with multiple risks:
- Unnecessary medication exposure,
- Higher cost to patients, side effects, and
- Increasing Antimicrobial Resistance (AMR). Experts warn that overprescribing antibiotics inflates the risk of resistant infections, which is already a growing problem globally
Path Forward: A Scientific Approach to Cough Management in India
To improve cough management in India, the study proposes several measures:
- Structured categorization: Cough cases should be clearly recorded (productive vs non-productive, allergic, etc.).
- Rational prescribing practices: Use of antibiotics should be based on evidence or indication avoiding fixed-dose or multi-ingredient treatments without justification.
- Training and diagnostic tools: More practical tools such as guidelines, flowcharts, and diagnostic aids should be provided to doctors to help them treat cough more effectively.
- Cough clinics: The study notes that organizations like Kenvue, in collaboration with the Association of Physicians of India, are launching “cough clinics” in several cities to pilot evidence-based cough evaluation and management. These clinics provide training modules and validated categorization tools for doctors.
- Alongside scientific categorization, incorporating Ayurvedic formulations with limited side effects can also play an important role, as they are known to target the root cause of cough rather than merely offering symptomatic relief.
Conclusion:
“Cough management in India” isn’t just about relieving symptoms—it’s about using clinical evidence, reducing antibiotic use, and protecting public health from the downstream effects of over-medication and resistance. With better classification, clearer guidelines, and stronger training, India can shift from generic cough treatment to smart, patient-specific care.
About The Author
