Click here to Enlarge
URTI and not systemically very unwell or at higher risk of complications- do not offer antibiotic
Acute bronchitis and not systemically very unwell or at higher risk of complications-Do not routinely offer an antibiotic-If acute cough associated with acute bronchitis and CRP is available- follow NICE pneumonia in adults guideline
Higher risk of complications – at face to face examination- Consider an immediate antibiotic or a back-up antibiotic prescription
Systemically very unwell – at face to face examination-Offer an immediate antibiotic
Advice on-usual course of acute cough -up to 3-4 weeks managing symptoms with self care when to seek medical help – for eg ○ symptoms worsen rapidly or significantly ○ do not improve after 3-4 weeks ○ person becomes systemically unwell If antibiotic not issued- advice why not If antibiotic issued – advice about SE’s particularly diarrhoea If back-up prescription – advice on using if symptoms worsen rapidly or significantly at any time
Do not offer a mucolytic an oral or inhaled bronchodilator an inhaled or oral corticosteroid Unless otherwise indicated
Reassess if symptoms worsen rapidly or significantly taking into account ○ alternative diagnoses such as pneumonia ○ any symptoms or signs suggesting a more serious illness or condition such as cardiorespiratory failure or sepsis ○ previous antibiotic use which may have led to resistance
Refer to hospital or seek specialist advice on further investigations and management if any symptoms or signs suggesting a more serious illness or condition for eg sepsis , a pulmonary embolism or lung cancer
background- acute coughs are usually self limiting but can last up to 3-4 weeks antibiotics make little difference to how long a cough lasts usually caused by a viral URTI such as a cold or flu also caused by acute bronchitis ( a lower resp tract infection ) which is usually viral but can also be bacterial
High risk-People with pre-existing comorbidity Young children born prematurely People > 65 with 2 or more of following older than 80 with any 1 of the following ○ hospitalization in previous year ○ type 1 or 2 diabetes ○ h/o CCF ○ current use of oral corticosteroids
Self-care honey -after 1 yr of age pelargonium ( herbal medicine ) in people aged 12 or over OTC cough medicines containing the expectorant guailfenisin age 12 + OTC cough suppressants except codeine ( in people aged 12 and over with non-persistent cough and without excessive secretions ) Limited evidence suggests antihistamines , decongestants and cough medicines containing codeine do not help cough symptoms
first line adults 18 and over- Doxycycline 200 mg first day and then 100 mg od for 4 days ( 5 days in total ) Doxyccline should not be given to pregnant women and consider possibility of pregnancy in women of child bearing age
Amoxicillin 500 mg tds x 5 days Clarithromycin 250 to 500 mg bd x 5 days Erythromycin 250-500 mg qds or 500 mg to 1000 mg bd x 5 days Pregnant women- amoxicillin or erythromycin are preferred
Amoxicillin 1-11 months 125 mg tds x 5 days 1-4 yrs 250 mg tds x 5 days 5-17 yrs 500 mg tds x 5 days
Clarithromycin 1 month to 11 yrs Under 8 kg 7.5 mg/ kg bd x 5 days 8-11 kgs 62.5 mg bd x 5 days 12-19 kgs 125 mg bd x 5 days 20-29 kgs 187.5 mg bd x 5 days 30-40 kgs 250 mg bd x 5 days 12-17 yrs 250-500 mg bd x 5 days
Erythromycin 1 month to 1 yr 125 mg qds x 5 days or 250 mg bd for 5 days 2-7 yrs 250 mg qds x 5 days or 500 mg bd x 5 days 8-17 yrs 250 mg-500 mg qds for 5 days or 500 mg -1000 mg bd x 5 days
Doxycycline 12-17 yrs 200 mg day 1 and then 100 mg od x 4 days ( 5 day course in total )
Based on Cough ( acute ) : antimicrobial prescribing NICE guideline 120 February 2019