Across India's clinics, a symptom as ancient and common as the cough has become a quiet theater of medical habit overriding science. A study of more than 22 lakh patient records reveals that most cough cases go uncategorized, and more than half of all patients receive antibiotics regardless of whether those drugs are warranted — a pattern that deepens the global crisis of antimicrobial resistance one prescription at a time. The findings remind us that the smallest clinical decisions, repeated millions of times, can reshape the health of an entire civilization.
India's cough treatment plagued by poor categorization, antibiotic overuse
Patients exposed to unnecessary medications causing preventable side-effects and contributing to antimicrobial resistance affecting population health.
Doctors cannot tailor treatment to what the patient actually has
Mark
Why does it matter so much how a cough is classified? Isn't treatment the same either way?
Mimi
No. A productive cough—one bringing up mucus—might need expectorants or time to clear on its own. A nonproductive cough might need something entirely different. An allergic cough needs antihistamines, not antibiotics. Without classification, doctors guess. And when they guess, they default to antibiotics because they're familiar and seem safe.
Mark
But antibiotics do kill bacteria. Doesn't that help?
Mimi
Only if bacteria are actually causing the cough. Most coughs are viral. Antibiotics do nothing for viruses. They just expose the patient to side effects and, more critically, they train bacteria in the body to resist those drugs. That resistance spreads. Eventually, the antibiotic stops working for anyone.
Mark
So this is about antimicrobial resistance?
Mimi
It's part of it. But it's also about basic clinical practice. If you don't know what you're treating, you can't treat it well. The study shows that 71 percent of adult cough cases weren't even classified. That's not medicine—that's habit.
Mark
What would change if these cough clinics actually took off?
Mimi
Doctors would have tools to categorize cough properly at the first visit. They'd have training on when antibiotics are actually needed. They'd document what they're seeing. Over time, prescribing patterns would shift. Patients would get the right treatment faster. Costs would fall. And the pressure on antimicrobial resistance would ease.
Mark
Is this a problem unique to India?
Mimi
No. But India sees enormous patient volumes and has high antibiotic use. The scale here makes it urgent. When you're treating millions of patients, small changes in prescribing practice have massive downstream effects.
The Pulse
- Over 60% of cough patients in India are receiving antibiotics they do not need, with azithromycin dispensed almost reflexively across productive and nonproductive cases alike.
- The root of the problem is diagnostic silence — 71% of adult cough cases are never classified by type, leaving doctors with no clinical anchor and habit filling the void.
- Each unnecessary prescription adds to a mounting toll: preventable side-effects for individual patients, rising healthcare costs, and accelerating antimicrobial resistance that threatens everyone.
- The Association of Physicians of India has called the findings stark, warning that casual antibiotic use for cough is actively fueling resistant infections at a moment when the world can least afford it.
- A partnership between API and Kenvue is launching dedicated cough clinics in ten cities, equipping physicians with validated categorization tools and structured training to anchor prescribing in evidence rather than instinct.
Across India's clinics, a symptom as ancient and common as the cough has become a quiet theater of medical habit overriding science. A study of more than 22 lakh patient records reveals that most cough cases go uncategorized, and more than half of all patients receive antibiotics regardless of whether those drugs are warranted — a pattern that deepens the global crisis of antimicrobial resistance one prescription at a time. The findings remind us that the smallest clinical decisions, repeated millions of times, can reshape the health of an entire civilization.
Walk into almost any clinic in India and cough will be near the top of the patient list. Yet a new study of more than 22 lakh records, published in the Journal of the Association of Physicians of India, reveals that this everyday complaint is being handled with striking inconsistency — driven more by habit than by science.
The core problem is categorization, or the absence of it. Among adult patients, 71% of cough cases were recorded simply as 'cough' — not productive or nonproductive, not allergic or infectious. Without that basic distinction, treatment cannot be tailored to what the patient actually has. So doctors reach for what they have always reached for: antibiotics. More than half of all cough patients received them. Among adults with nonproductive cough — where antibiotics are rarely indicated — 53.1% were prescribed them anyway. Azithromycin dominated, followed by cefpodoxime and fixed-dose combinations of questionable efficacy.
The consequences extend well beyond the individual patient. Unnecessary medications bring unnecessary side-effects. Costs rise. And antimicrobial resistance — already one of modern medicine's gravest threats — deepens with every unwarranted prescription. Agam Vora, General Secretary of API, described the findings as alarming, noting that drugs are being prescribed even when they are not indicated, accelerating a resistance crisis the world is already struggling to contain.
The study also points toward a path forward. API and Kenvue are launching dedicated cough clinics across ten cities, starting at BSES Hospital in Mumbai, where physicians will receive validated diagnostic tools and training in rational prescribing. The ambition is to make evidence-based categorization a reflex rather than an exception. For now, millions of patients continue to receive antibiotics for coughs that do not need them — and whether India's medical system can translate this precise diagnosis of the problem into lasting change remains an open question.
Walk into a clinic in India on any given day, and you will find cough at the top of the patient list. It is one of the most common reasons people seek medical care. Yet a new study of more than 22 lakh patient records reveals something troubling: doctors are treating this ubiquitous symptom with almost no consistency, guided more by habit than by science.
The research, published in the Journal of the Association of Physicians of India, exposes a fundamental gap in how cough is being managed across the country. Most cases are simply recorded as cough—nothing more. They are not classified as productive or nonproductive. They are not noted as allergic or infectious. Among adults, 71 percent of cough cases went unclassified. Among elderly patients, the figure was 66 percent. This absence of basic categorization has a direct consequence: doctors cannot tailor treatment to what the patient actually has. Instead, they reach for what they have always reached for.
What they reach for, overwhelmingly, is antibiotics. The data shows that more than half of all cough patients received antibiotics, regardless of whether those drugs were warranted. Among adults with productive cough—the kind that brings up mucus—60.3 percent were prescribed antibiotics. Among those with nonproductive cough, where antibiotics are rarely indicated, 53.1 percent still received them. The elderly saw similar patterns: 62 percent of those with productive cough and 52.3 percent with nonproductive cough were given antibiotics. Azithromycin was the most frequently prescribed, followed by cefpodoxime. Fixed-dose combinations like amoxicillin with clavulanic acid were also common. Alongside these, doctors continued to prescribe multi-ingredient cough syrups—formulations containing multiple active ingredients, often with questionable efficacy.
The consequences ripple outward. Patients are exposed to unnecessary medications and their side effects. Healthcare costs climb. And the problem that haunts modern medicine deepens: antimicrobial resistance. When antibiotics are used without clear indication, bacteria develop resistance to them. The world is already struggling with infections that no longer respond to standard drugs. India's casual approach to cough treatment is accelerating that crisis.
Agam Vora, General Secretary of the Association of Physicians of India, called the findings stark. Cough, he noted, is one of the most common health complaints in the country, yet it continues to be treated without scientific consistency. This undermines patient care, he said, prolongs symptoms, and exposes people to medicines they do not need. The overuse of antibiotics in cough management is alarming, he added—drugs are being prescribed even when they are not indicated, and this practice is fueling antimicrobial resistance at a time when the world is already grappling with resistant infections.
The study points toward a solution. Doctors need practical tools, not just broad recommendations. Kenvue, the consumer health company that conducted the research, has partnered with the Association of Physicians of India to launch dedicated cough clinics across ten cities, beginning with one at BSES Hospital in Mumbai. These clinics will provide physicians with validated categorization tools, structured training modules, and real-world guidance on rational prescribing. The aim is to shift everyday clinical practice toward evidence-based recommendations, prioritizing rational prescribing and strict categorization of cough at the point of diagnosis.
For now, the gap remains. Millions of patients continue to receive antibiotics for coughs that do not need them, driving up costs and resistance. The study has named the problem with precision. Whether India's medical system can act on that knowledge remains to be seen.
Notable Quotes
Cough, despite being one of the most common health complaints, continues to be treated in ways that lack scientific consistency. This undermines patient care, prolongs symptoms, and exposes people to unnecessary medicines.— Agam Vora, General Secretary, Association of Physicians of India
India must urgently align everyday clinical practice with evidence-based recommendations, prioritising rational prescribing and strict categorisation. Only then can we safeguard both individual patients and the healthcare system at large.— Agam Vora, General Secretary, Association of Physicians of India
Want the full story?
Read the original at The Hindu ↗
Health & Medicine