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Acute respiratory tract infections are common globally, resulting in a significant rise in antibiotic usage. This study investigates the use of various treatments and their impact on antibiotic usage and patient-reported clinical recovery in Chinese adults with acute cough. An online survey was conducted to recruit individuals who recently had a cough. Data on sociodemographic factors, clinical characteristics, received treatments, and perceived changes in symptoms were collected. Factors influencing antibiotic avoidance and symptom improvement were examined.

A total of 22,787 Chinese adults with recent acute cough participated in the survey, covering all 34 province-level administrative units in China. Most respondents were male (68.0%), young (89.4%, aged 18–45), and educated to university/degree or postgraduate level (44.6%). The median cough severity was reported as 6/10 on a numerical rating scale. Approximately 46.4% of participants reported antibiotic usage, with 93.1% for presumed upper respiratory tract infections (URTIs). Pharmacies were the most common source of antibiotics (48.8%). A lower percentage of patients used antibiotics after traditional Chinese herbal medicine (CHM) treatment (14.9%), compared to those who used home remedies (18.0%) or allopathic non-antibiotic medication (25.0%). Antibiotics, allopathic non-antibiotic medications, CHM, and home remedies were all perceived as beneficial in relieving cough symptoms.

Chinese adults utilise a diverse range of treatments for acute cough. Patient-reported clinical recovery was similar across different treatment modalities. There appears to be a considerable proportion of inappropriate antibiotic use for treating simple acute cough. Given that the majority of respondents did not use antibiotics as a first-line treatment and CHM usage was associated with cough symptom relief and reduced antibiotic consumption, this presents a significant opportunity for prudent antibiotic stewardship in China.