Use of Chinese herbal medicines for acute cough in China: An online survey

Introduction: Anti-microbial resistance is a complex and evolving global public health threat. Promoting effective alternative treatments is an important way to reduce the unnecessary use of antibiotics. This study aimed to identify the use of treatments for acute cough in China, including Chinese herbal medicines (CHMs) and their association with avoidance of antibiotics and participants' reported clinical recovery.Methods: An online retrospective treatment outcome survey was conducted. Retrospective clinical information was collected on participants who either were experiencing acute cough, or had experienced acute cough in the last 3 months. Participants were recruited through WeChat (a QR code or a link to the online survey), using snowball sampling. We analysed the usage of different CHMs, changes in symptoms as measured by Likert scales and subsequent use of antibiotics.Results: A total of 25,583 participants completed the online questionnaire, covering all 34 province-level administrative units in China. Respondents had a median age of 25 years (73.5%, aged 18-39). Most respondents reported sputum (65.8%). Nearly half of the participants (45.3%) reported using antibiotics, 39.4% using CHMs, 27.1% and 20.9% using non-antibiotic Western medications and home remedies respectively. Fewer participants took antibiotics after taking CHMs (14.4%), compared to those who started with home remedies (17.6%), or non-antibiotic Western medications (24.5%). The recommendation of doctors (62.4%) and pharmacies (32.1%) were the most common reason for choosing CHMs. Participant-reported clinical recovery was similar (same median of 4 on a 1-5 Likert self-rating scale) regardless of type of CHM. The five CHMs associated with the lowest proportions of subsequent antibiotic use were individualised Chinese herbal formulae, Xiao Qing Long granule, Xian Zhu Li liquid, Chuan Bei Pi Pa Gao and Shi Wu Wei Long Dan Hua pill. The most commonly used herbs in the Chinese patent medicines were Glycyrrhizae radix et rhizome, Platycodonis radix, Pinelliae rhizome, Armeniacae semen amarum, Ephedrae herba, and Citri reticulatae pericarpium.Conclusion: Almost 40% of participants with acute cough used CHMs. The proportion of participants who subsequently used antibiotics after CHMs was lower than other treatments. CHMs have a potential role for symptom relief thus reducing antibiotic use.