It is probably inadvisable to use cough suppressants.
- Results from 13 randomized controlled trials involving 1914 adults and children with symptoms of cough and productive sputum, or with a physician's diagnosis of acute bronchitis, indicate that antibiotics may have beneficial effects in acute bronchitis; however, some of the benefits are slight and need to be balanced against costs, adverse effects, and negative effects on antibiotic resistance pattern. (1)
- Use of antibiotics (2):
- antibiotic little benefit if no co-morbidity
- consider 7 day delayed antibiotic with advice
- symptom resolution can take 3 weeks
- consider immediate antibiotics if > 80yr and ONE of:
- hospitalisation in past year, oral steroids, diabetic, congestive heart failure
- OR > 65yrs with 2 of above
- if antibiotic treatment is initiated
- on the limited occasions when an antibiotic is indicated, a five-day course of amoxicillin (500mg three times a day), oxytetracycline (250-500mg four times a day) or doxycycline (200mg on the first day, then 100mg daily) is a suitable first choice (doses quoted are for adults) (1,3)
Notes:
- little evidence to support the use of oral or inhaled beta 2-agonists (e.g. salbutamol) in adults or children with acute cough or bronchitis and no underlying pulmonary disease (3)
- a Cochrane review found that patients given b2-agonists were more likely to report tremor, shakiness, or nervousness than patients in the control group (3)
- analgesics and antipyretics may be used where appropriate
- insufficient evidence to support the use of other over-the-counter cough medicines
- simplest and cheapest treatment for a cough may be a home remedy such as honey and lemon
Reference:
(1) Smucny J, Fahey T, Becker L, Glazier R. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD000245. doi: 10.1002/14651858.CD000245.pub2. Update in: Cochrane Database Syst Rev. 2014;3:CD000245. PMID: 15494994.
(2) Smith MP, Lown M, Singh S, Ireland B, Hill AT, Linder JA, Irwin RS; CHEST Expert Cough Panel. Acute Cough Due to Acute Bronchitis in Immunocompetent Adult Outpatients: CHEST Expert Panel Report. Chest. 2020 May;157(5):1256-1265. doi: 10.1016/j.chest.2020.
(3) National Institute for Health and Care Excellence. Cough (Acute): Antimicrobial Prescribing. Vol. 2019. www.nice.org.uk/guidance/ng120 (2019).