Acute Cough, Bronchitis (Adults) - Antibiotic Prescribing

Comments from Expert Advisory Committee

  1. Consider coronavirus as a differential diagnosis in a patient presenting with a cough and follow HPSC guidance on assessment and testing.
  2. In otherwise healthy individuals, >90% cases of acute bronchitis are viral and antibiotics offer limited or no benefit.
  3. Advise on symptom control, rest and hydration (see symptom relief below).
  4. Advise patient that acute cough may persist for up to 3-4 weeks.
  5. Advise patient to seek medical attention if symptoms worsen rapidly or significantly, or they become systemically very unwell.
  6. Consider immediate or delayed antibiotic in acute cough and higher risk of complications (e.g. people with pre-existing comorbidity; young children born prematurely; people over 65 with 2 or more of, or over 80 with 1 or more of: hospitalisation in previous year, type 1 or 2 diabetes, history of congestive heart failure, current use of oral corticosteroids.
  7. Consider immediate antibiotics if acute cough and systemically very unwell.

Symptom relief

  1. Honey (e.g. hot water with honey and lemon) can be used for soothing effect.
  2. Dextromethorphan, and guianefesin-containing products (available over the counter in pharmacies) have some evidence for alleviating symptoms.
  3. Diphenhydramine (sedative antihistamine) may help reduce symptoms, but has sedative and anticholinergic effects.
  4. Codeine based products are not recommended as they have no proven efficacy and pose risk of adverse effects.
  5. Mucolytics (e.g. carbocysteine) not recommended for acute bronchitis/cough.
  6. Paracetamol and ibuprofen (if not contraindicated) recommended for associated pain. 

Treatment

bronchitis 040321_2

* Alternative doxycycline dose: 100mg every 12 hours. In non-severe infection, 200mg stat then 100mg every 24 hours can be considered.


Patient Information


Safe Prescribing (visit the safe prescribing page)

Reviewed February 2021

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