Cough Treatment

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Cough

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A cough occurs when you have a reflex action that forces air up and out of the lungs. An acute cough lasts less than 3 weeks, and if it lasts longer then it is advisable to see your GP for a physical assessment. Acute cough will usually improve after one week.

The most common cause of an acute cough is a viral infection which usually will settle on its own without any specific treatment. Rest, drinking fluids and taking paracetamol will usually help it settle. 

Respiratory tract infections can either be

Unnecessary use of antibiotics may cause side effects and may increase the incidence of antibiotic resistance.

Please visit the following site for further information regarding the condition:

patient.info/health/cough-leaflet


Common Symptoms

Common Symptoms of a Respiratory Tract Infection

  • Cough
  • Mucous (Phlegm)
  • Low-Grade Fever
  • Runny nose
  • Sneezing
  • Blocked nose
  • Sore throat
  • General aches and pains

Most symptoms are at their worst after 2 to 3 days then will gradually settle. A cough may remain, however, for a couple of weeks, even after the infection has gone, but you would usually feel well in yourself at this stage.

Common Treatments

Most Respiratory Tract Infections are viral, do not require antibiotics, and will improve within a week on their own. Common treatments for the symptoms include paracetamol or ibuprofen, which help with any aches or pains and fever. You can seek further advice about cough and cold remedies from your pharmacist.

Possible treatments we may prescribe if clinically appropriate:

  • Amoxicillin 500mg Three Times Per Day - 5 Day Course £1.57
  • Doxycycline 100mg 2 Immediately Then 1 Per Day - 5 Day Course £1.07

Prices shown are cost price of the medication, taken from the British National Formulary 2016, and are given as a guideline. Pharmacies will add on a dispensing fee to this which will vary considerably, so it is worthwhile checking with the pharmacy to find out their exact cost.

Symptoms unsuitable for i-GP

There are certain symptoms that may be present with a cough that suggests you should see a doctor in person, as soon as possible, for a physical assessment and you may require further investigation.

  • If your cough has lasted longer than 3 weeks
  • Coughing up blood
  • Any unexplained weight loss
  • Night sweats

If you develop any of the following symptoms, then you must seek urgent medical advice immediately (from your GP, Out of Hours Service, Urgent care centre, NHS 111) or call an ambulance if the symptoms are severe:-

  • Difficulty in breathing
  • Chest pain
  • Severe headache
  • Drowsiness or confusion
  • Persistent vomiting
  • Neck stiffness
  • Non-blanching rash
Causes of cough

Common causes of an acute cough

  • Upper respiratory tract infections. These will usually improve within 1 week, without any specific treatment, but milder symptoms may last up to 3 weeks.
  • Lower Respiratory Tract Infections. These include Acute Bronchitis and chest infections. 
  • Asthma
  • Irritants in the air may irritate the airways

Subacute Cough (lasting between 3 and 8 weeks)

  • Airway hyper-responsiveness. Even after an infection of the airways settles, they may still be irritable and swollen, and this can cause the cough to continue for a few more weeks.
  • Other airway infections such as TB

Common causes of a chronic cough (lasting over 8 weeks)

  • Postnasal drip. This can be caused by allergies, nasal polyps and infections. It is where mucous from the nose drips down the back of the throat, causing airway irritation. 
  • Acid reflux. This is where acid from the stomach passes up the gullet and into the airways, this can cause airway irritation.
  • Asthma
  • Medication side effects
  • Smoking
When to seek further advice

If your symptoms do not improve within 3 weeks or seem to be worsening instead of improving after a week, then it is important to seek medical advice. 

If you develop any of the following symptoms, then you must seek urgent medical advice immediately (from your GP, Out of Hours Service, Urgent care centre, NHS 111) or call an ambulance if the symptoms are severe:-

  • Difficulty in breathing
  • Chest pain
  • Severe headache
  • Drowsiness or confusion
  • Persistent vomiting
  • Neck stiffness
  • Non-blanching rash

 

Amoxicillin Information

Do not take Amoxicillin if you are allergic to penicillin.

Please fully read the Patient Information Leaflet that comes with the medication before starting treatment. 

This will contain more comprehensive information and a full list of side effects. 

How to take Amoxicillin

These capsules may be taken before, during or after your meals.

Remember to finish the course as prescribed.

 

Allergic Reactions

An itchy rash, swollen face or mouth, or have difficulty breathing, these may be signs that you are allergic to the antibiotic. 

Please note that i-GP DOES NOT TREAT Medical Emergencies. 

If you develop any sudden onset of the following then you must STOP the medication and seek urgent medical advice (from your GP, Out of Hours Service, Urgent care centre or NHS 111) or call an ambulance if the symptoms are severe:-

  • Wheeze
  • Difficulty in Breathing
  • Swelling of the eyelids, face or lips
  • A rash particularly if affecting your entire body

Possible Side Effects

All medications have the potential to cause side effects, but not everyone experiences them.The most common ones include

  • Feeling sick (nausea) or vomiting
  • Diarrhoea
  • Redness and itching in the mouth or vagina (thrush)
  • Skin rashes
Doxycycline Information

Please fully read the Patient Information Leaflet provided with the medication, before starting treatment. 

This will contain more comprehensive information and a full list of side effects. 

How to take Doxycycline

You should not drink alcohol while taking Doxycycline capsules.

Do not take indigestion remedies, or supplements containing iron, magnesium, or zinc at the same time as doxycycline as they stop it from working properly.

Swallow the capsules whole with a full glass of water, if the capsules irritate your stomach take them with food or milk while either sitting down or standing up. Take them well before you go to bed for the night to stop irritation and ulceration of your gullet. It is important not to lie down for at least thirty minutes after taking Doxycycline capsules.

Remember to finish the course as prescribed.

Driving and using machines

Do not drive or use machines if you suffer from visual disturbances such as blurring of vision while taking Doxycycline.

Allergic Reactions

Doxycycline can occasionally cause allergic reactions. An itchy rash, swollen face or mouth, or have difficulty breathing; these may be signs that you are allergic to the antibiotic. 

Please note that i-GP DOES NOT TREAT Medical Emergencies. 

If you develop any sudden onset of the following then you must STOP the medication and seek urgent medical advice (from your GP, Out of Hours Service, Urgent care centre or NHS 111) or call an ambulance if the symptoms are severe:-

  • Wheeze
  • Difficulty in Breathing
  • Swelling of the eyelids, face or lips
  • A rash particularly if affecting your entire body

Possible Side Effects

All medications have the potential to cause side effects, but not everyone experiences them. Doxycycline is generally well tolerated by most people but the side effects include:

  • Stomach upset, indigestion, abdominal pain
  • Diarrhoea
  • Redness and itching in the mouth or vagina (thrush)
  • Dry mouth, throat irritation
  • Feeling anxious, increased sweating
  • A headache, other aches and pains

Stop taking the capsules immediately and seek urgent medical advice in the following circumstances:

  • Photosensitivity: if you notice that your skin is very sensitive to light (you may get a skin rash, itching, redness or severe sunburn when out in sunlight or after using a sun bed).
  • Severe skin reactions: this includes erythema multiforme (circular, irregular red patches), Stevens- Johnson syndrome (rash with flushing, fever, blisters or ulcers), toxic epidermal necrolysis (reddening, peeling and swelling that resembles burns).

Antibiotic Resistance

Antibiotics should be used responsibly and only when really necessary. Overuse and misuse of antibiotics can lead to antibiotic resistance. This is where the antibiotic becomes less effective at treating certain types of bacterial infection, so they do not work when needed. 

Antibiotics should be taken as prescribed, and it is important to complete the full course, this can reduce the chance of the bacteria developing an immunity to that antibiotic. It is important not to share antibiotics, and always take unused medication to your local pharmacy for disposal.

References

British Thoracic Society (BTS) guideline Recommendations for the management of cough in adults[Morice et al, 2006]

American College of Chest Physicians (ACCP) guideline An empiric integrative approach to the management of cough. [Pratter et al, 2006]

National Institute for Health and Care Excellence (NICE) guideline Respiratory tract infections (self-limiting): prescribing antibiotics

Institute for Clinical Systems Improvement guideline Diagnosis and Treatment of Respiratory Illness in Children and Adults [ICSI, 2013].

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