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Objective To describe variation in antibiotic prescribing for acute cough in contrasting European settings and the impact on recovery.

Design Cross sectional observational study with clinicians from 14 primary care research networks in 13 European countries who recorded symptoms on presentation and management. Patients followed up for 28 days with patient diaries.

Setting Primary care.

Participants Adults with a new or worsening cough or clinical presentation suggestive of lower respiratory tract infection.

Main outcome measures Prescribing of antibiotics by clinicians and total symptom severity scores over time.

Results 3402 patients were recruited (clinicians completed a case report form for 99% (3368) of participants and 80% (2714) returned a symptom diary). Mean symptom severity scores at presentation ranged from 19 (scale range 0 to 100) in networks based in Spain and Italy to 38 in the network based in …