Acute Cough, Bronchitis (Adults) - Antibiotic Prescribing

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, most 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 years with 2 or more of, or over 80 years 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.

Symptom relief

1. Honey (e.g. hot water with honey and lemon) can be used for soothing effect.
2. Dextromethorphan, and guaifenesin-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 are not recommended for acute bronchitis/cough.
6. Paracetamol and (if appropriate ibuprofen) are recommended for associated pain.
7. Advise to consult pharmacist for symptom relief.

Treatment

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

Patient Information

• We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.
• HSE information: cough
• HSE information: coronavirus

Safe Prescribing (visit the safe prescribing page)

• Doses are oral and for adults unless otherwise stated
• Clarithromycin and other macrolides warning
• Penicillin allergy – tips on prescribing in penicillin allergy
• Renal impairment dosing table
• Safety in Pregnancy and Lactation
• Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
• Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed October 2021