Comments from Expert Advisory Committee
- Consider coronavirus as a differential diagnosis in a patient presenting with a cough and follow HPSC guidance on assessment and testing.
- In otherwise healthy individuals, >90% cases of acute bronchitis are viral and antibiotics offer limited or no benefit.
- Advise on symptom control, rest and hydration (see symptom relief below).
- Advise patient that acute cough may persist for up to 3-4 weeks.
- Advise patient to seek medical attention if symptoms worsen rapidly or significantly, or they become systemically very unwell.
- 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.
- Consider immediate antibiotics if acute cough and systemically very unwell.
- Honey (e.g. hot water with honey and lemon) can be used for soothing effect.
- Dextromethorphan, and guianefesin-containing products (available over the counter in pharmacies) have some evidence for alleviating symptoms.
- Diphenhydramine (sedative antihistamine) may help reduce symptoms, but has sedative and anticholinergic effects.
- Codeine based products are not recommended as they have no proven efficacy and pose risk of adverse effects.
- Mucolytics (e.g. carbocysteine) not recommended for acute bronchitis/cough.
- Paracetamol and ibuprofen (if not contraindicated) recommended for associated pain.
* Alternative doxycycline dose: 100mg every 12 hours.
In non-severe infection, 200mg stat then 100mg every 24 hours can be considered.
Reviewed February 2021