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Formulary
Management of cough, acute and bronchitis, acute
The information below is based on NICE NG120 Cough (acute): antimicrobial prescribing (February 2019).
Acute cough is self-limiting, and symptoms can resolve within 3 to 4 weeks. It is commonly caused by a viral upper respiratory tract infection, but it can also be caused by acute bronchitis, a lower respiratory tract infection, which is usually a viral infection but can be bacterial.
For children under 5 years who present with an acute cough and fever refer to NICE NG143: Fever in under 5s: assessment and initial management (November 2019)
| SELF-CARE: NHS England has published guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care. These conditions include coughs, colds, and nasal congestion. Patients may wish to try self-care treatments, which have limited evidence of some benefit for the relief of cough symptoms; e.g. honey (in people aged over 1 year), over the counter cough suppressants or expectorants. Many products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. |
Limited evidence suggests that antihistamines, decongestants and codeine-containing cough medicine do not help cough symptoms.
Do not offer oral or inhaled bronchodilators or corticosteroids to people for an acute cough associated with an upper respiratory tract infection or acute bronchitis unless the person has underlying airways disease such as asthma.
Do not offer mucolytics to treat acute cough.
Acute cough associated with an upper respiratory tract infection or acute bronchitis
Do not offer an antibiotic to treat an acute cough associated with an upper respiratory tract infection or acute bronchitis in people who are not systemically very unwell or at higher risk of complications.
Antibiotics do not improve overall clinical condition of people with acute bronchitis and make little difference to how long symptoms last.
Immediate prescription of antibiotics is recommended in patients who:
- Are systemically very unwell, as identified at a face-to-face clinical examination
Consider immediate prescription of antibiotics or a 5-day prescription (delayed for 7 days) in patients who:
- Are at risk of developing complications because of pre-existing co-morbidity, including significant heart, lung, renal, liver or neuromuscular disease, immunosuppression, cystic fibrosis and young children born prematurely
- Are older than 65 years with two or more of the following criteria; or older than 80 years with one of more of the following criteria:
- Hospitalisation in previous year
- Type 1 or type 2 diabetes
- History of congestive heart failure
- Current use of oral corticosteroids
Where antibiotics are indicated
Doxycycline is contraindicated in pregnancy, and the possibility of pregnancy should be considered in young women of childbearing age.
Amoxicillin or erythromycin are preferred in women who are pregnant
Adults aged 18 years and over
Doxycycline
- 200mg on first day, then 100 mg once a day for 4 days (5‑day course in total)
Amoxicillin
- 500mg three times a day for 5 days
Clarithromycin
- 250mg to 500mg twice a day for 5 days
Erythromycin
- 250mg to 500mg four times a day or 500mg to 1,000mg twice a day for 5 days
Children and young people under 18 years
Amoxicillin
- 1 month to 11 months: 125mg three times a day for 5 days
- 1 to 4 years: 250mg three times a day for 5 days
- 5 to 17 years: 500mg three times a day for 5 days
Clarithromycin
- Children 1 month to 11 years of age (doses given twice daily for 5 days):
- Body-weight under 8 kg: 7.5mg/kg
- Body-weight 8–11 kg: 62.5mg
- Body-weight 12–19 kg: 125mg
- Body-weight 20–29 kg: 187.5mg
- Body-weight 30–40 kg: 250mg
- Children and young people 12 to 17 years of age:
- 250mg to 500mg twice daily for 5 days
Erythromycin
- Children 1 month to 17 years of age (doses given for 5 days)
- 1 month to 23 months: 125mg four times a day or 250mg twice a day
- 2 to 7 years: 250mg four times a day or 500mg twice a day
- 8 to 17 years: 250mg to 500mg four times day or 500mg to 1,000mg twice a day
MHRA Drug Safety Update (December 2020): Erythromycin: update on known risk of infantile hypertrophic pyloric stenosis
Doxycycline
- Children and young people 12 to 17 years of age:
- 200 mg on first day, then 100 mg once a day for 4 days (5‑day course in total)
See section: 5.1.1 Penicillins, 5.1.3 Tetracyclines, and 5.1.5 Macrolides
Reassess at any time if symptoms worsen rapidly or significantly, taking account of:
- Alternative diagnoses, such as pneumonia (community-acquired)
- Any symptoms or signs suggesting a more serious illness or condition, such as cardiorespiratory failure or sepsis
- Previous antibiotic use, which may lead to resistant organisms
The following Referral Guidelines are available locally:
- Persistent cough in adults
- Cough (chronic) in children
