What factors influence prognosis in children with acute cough and respiratory tract infection in primary care?

Cough is the commonest reason for preschool children to see a general practitioner,1 with primary care costs conservatively estimated at £31 million (€38.4 million; $50.3 million) a year for this age group alone.2 Acute cough has been shown to last longer than two weeks in a quarter of preschool children, and up to 12% of children could have deterioration in their condition necessitating reconsultation or complications, including pneumonia.3

Primary care clinicians attempt to balance the need to reduce unnecessary antibiotic prescriptions with the prevention of complications from respiratory tract infections. However, recent guidance from the National Institute for Health and Clinical Excellence4 acknowledged that a key driver for increased antibiotic prescriptions is clinical uncertainty in identifying those children most likely to develop complications or who need hospital care for respiratory infections—that is, those at risk of poorer prognosis. This uncertainty is evident from the wide variation in prescribing rates between individual clinicians, general practices, and countries.5 6 7