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Cough, one of the most common clinical complaints in India, is being managed in ways that lack scientific rigor and consistency, according to a recent study by Kenvue, makers of Benadryl. The analysis underscores critical gaps in cough evaluation and widespread overprescription of antibiotics, raising concerns about increased healthcare costs, unnecessary side effects, and the accelerating threat of antimicrobial resistance (AMR). This article reviews the study’s key findings, expert commentary, and implications for public health, stressing the urgent need for evidence-based, rational management of cough in India.
Study Overview and Key Findings
The study analyzed real-world cough management patterns across adult and elderly populations in India. It found that a majority of cases—71.04% of adults and 66.42% of elderly patients—were classified simply as “unspecified” coughs, with no clear categorization into productive (wet) or nonproductive (dry) cough, or underlying allergic causes. Proper classification is essential because treatment strategies differ significantly depending on cough type.
Antibiotic use was alarmingly high across all cough types: 60.3% of adults with productive coughs and 53.1% with nonproductive coughs received antibiotics; among the elderly, these numbers were 62% and 52.3%, respectively. Azithromycin was the most frequently prescribed antibiotic, followed by cefpodoxime. Fixed-dose antibiotic combinations such as amoxicillin with clavulanic acid were also commonly used. Additionally, the study flagged the persistent use of multi-ingredient cough formulations, many of which lack sound scientific support.
Expert Perspectives
Dr. Agam Vora, General Secretary of the Association of Physicians of India (API), described the findings as deeply concerning. “Despite cough being one of the most common health complaints, treatment approaches continue to lack scientific consistency,” he noted. “Overuse of antibiotics, including in cases where they are not indicated, fuels antimicrobial resistance—one of the greatest global health threats of our time. Moreover, irrational multi-ingredient cough syrups compound the problem.”
Dr. Vora emphasized the need for better documentation, tailored treatment, and rational prescribing, saying, “India must urgently align everyday clinical practice with evidence-based recommendations to protect patients and the healthcare system.”
Dr. Harshad Malve, Medical Head of Self Care and Operations at Kenvue India, highlighted efforts to address these gaps through practical solutions. “Doctors need validated categorization tools and structured training—not just broad recommendations,” he said. To this end, Kenvue collaborated with the API to launch dedicated cough clinics in 10 cities, starting with BSES Hospital in Mumbai. These clinics provide physicians tools for accurate cough classification and emphasize rational antibiotic use.
Context and Background
Cough is a symptom, not a disease, caused by a variety of factors including infections, allergies, chronic respiratory conditions, and environmental irritants. Correct classification into productive or nonproductive cough guides appropriate treatment: productive coughs may need expectorants or targeted antibiotics if bacterial infection is evident, while nonproductive coughs often respond to symptomatic treatment or addressing underlying causes.
The irrational overuse of antibiotics in cough is a global concern due to risks of side effects, increased costs, and most critically, antimicrobial resistance. India bears a significant burden of AMR due to widespread antibiotic misuse, threatening the effectiveness of life-saving drugs.
Implications for Public Health
This study’s findings underscore the urgent public health need for standardized cough management protocols emphasizing scientific classification and rational antibiotic prescribing. Improved training and diagnostic tools can enhance clinical outcomes, reduce unnecessary medication exposure, and slow AMR progression.
Equally important is public awareness that not all coughs require antibiotics or complex multi-ingredient formulations, which often lack efficacy and safety data. Health literacy initiatives can empower consumers to seek appropriate medical advice and question unnecessary prescriptions.
Limitations and Counterarguments
While the study highlights concerning trends, it relies on prescription and classification data that may underrepresent the clinical complexity or comorbidities influencing treatment decisions. Some clinicians argue that empirical antibiotic use in certain cases may be justified due to diagnostic limitations or risks of secondary bacterial infections. However, such exceptions should not justify generalized overuse.
Continued research and surveillance are needed to monitor cough management practices, antibiotic prescribing patterns, and AMR trends in outpatient settings across India.
Practical Recommendations for Readers
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Seek medical evaluation for cough lasting more than 2-3 weeks, worsening symptoms, or associated with fever, breathlessness, or blood.
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Question antibiotic prescriptions for cough unless bacterial infection is confirmed or strongly suspected.
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Avoid multi-ingredient cough syrups without proven efficacy and consult healthcare professionals for clearer guidance.
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Follow up with doctors regarding cough assessment and management plans emphasizing symptom type and underlying cause.
Conclusion
The Kenvue study reveals urgent gaps in scientific cough management in India, with excessive antibiotic use and poor classification threatening patient safety and public health. Aligning clinical practice with evidence-based standards through validated tools, education, and rational prescribing will be essential to improve care and combat antimicrobial resistance.
Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.
References
- https://health.economictimes.indiatimes.com/amp/news/industry/urgent-need-for-scientific-cough-management-in-india-study-uncovers-alarming-trends/123933091
