Cough Treatment

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Cough

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Before you start a diagnosis, please read all of the information below.

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. An acute cough caused by an infection will usually improve after one week, however, it may take up to 3 weeks for the symptoms to settle completely.

The most common cause of an acute cough is a viral infection affecting the respiratory tract (breathing passages including the nose, mouth, throat, airways and lungs). Many respiratory tract infections will settle on their own without any specific treatment. Rest, drinking fluids and taking over-the-counter treatments as advised by your pharmacist will usually help the symptoms settle. Antibiotics are usually not required in the treatment of most coughs. Unnecessary use of antibiotics may cause side effects and may increase the incidence of antibiotic resistance. They are reserved for consideration in cases where the symptoms are not improving or if the infection has settled on the chest. 

Please see the Common Treatments section below for further information.


Common Symptoms

Symptoms of a Respiratory Tract Infection include:

  • a cough
  • mucous (phlegm)
  • a low-grade fever
  • a runny nose
  • sneezing
  • a blocked nose
  • a 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. Please note that symptoms of a viral cough may take up to three weeks to settle.

If however, you feel that your cough has settled on your chest or if your symptoms are worsening instead of improving, then you may wish to 'Start a Diagnosis' with i-GP or see your own GP.

Possible treatments we may prescribe if clinically appropriate:

  • Amoxicillin 500mg three times daily: 5-day course (£0.82*)
  • Doxycycline 100mg 2 immediately then one a day: 5-day course (£0.81*)
  • Clarithromycin 500mg twice daily: 5-day course (£1.97*)

*Prices shown are cost price of the medication, taken from the British National Formulary 2018, and are given as a guideline. Pharmacies will add a dispensing fee to this which will vary considerably, so it is worthwhile phoning around to compare prices. The medication is paid for at your chosen pharmacy. 

Please click on the medication above to read the Patient Information Leaflet for important information about each drug. We use national prescribing guidelines to select which treatment would be most appropriate for your condition. 

Respiratory Tract Infections

The two types of respiratory tract infections include: 

  • Upper Respiratory Tract Infection (URTI) which affects the nose, sinuses and throat.
  • Lower Respiratory Tract Infection (LRTI) which affects the breathing tubes (trachea and bronchi) and lungs.

Respiratory tract infections spread through coughing, sneezing or breathing droplets which are infected with the germs. If these are breathed in by someone else, then the infection may be passed on. The infection can also be spread through direct contact with another person or through indirect contact, such touching surfaces which are contaminated with the germs. 

To prevent spreading infections, it is important to practise good hygiene. This would include washing your hands with soap and warm water regularly, especially after coughing, sneezing or wiping your nose.

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, the airways may still be irritable and swollen, and this can cause the cough to continue for a few more weeks
  • Other uncommon 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
Self-help for the symptoms

There are certain treatments you can try at home which may help you to manage your symptoms.

Pain medication 

  • such as paracetamol or ibuprofen. Read the leaflet that comes with the medication to check its suitability. This can help with pain and fever.

Cough Medicines

  • some people find that cough medicines can work well. Speak to your local pharmacist so they can help you select the correct one.

Over-the-counter Decongestant nasal sprays or drops

  • may help with a blocked nose to allow you to breathe through it better. Check with the pharmacist first to ensure they are suitable for you. Do not use them for more than a week. 

Saline (salt water) nasal drops

  • can help reduce the nasal discharge and unblock your nose.

Warm face packs

  • may help ease the sinus pain and help drain the mucus.

Drinking water

  • to keep hydrated and to prevent mild loss of water from the body (dehydration). Dehydration may develop if you have a high temperature and it can make a headache and tiredness much worse.

Steam Inhalation

  • there is not very much evidence that this helps but some people find it provides temporary relief.

Echinacea purpurea

  • Recent research has shown that some herbal remedies containing Echinacea purpurea might decrease the severity of your cough and associated symptoms.

A balanced and healthy diet

  • can also boost your immune system and quicken your recovery time. In particular, food rich in zinc has been suggested to help you overcome such infections. Regular exercise has also been shown to possibly reduce the incidence of upper respiratory tract infections and shorten the duration of your symptoms.
Smoking

If you smoke, it can often lead to recurrent chest infections or a chronic cough. Quitting is likely to help improve your cough.

You can find out more about the options available to help you stop, here.

Treating your infection without antibiotics

Information about Amoxicillin

Amoxicillin is recommended as first-line treatment if an antibiotic is prescribed for a respiratory tract infection unless you are allergic to penicillins. If you are allergic to penicillins then Doxycycline or Clarithromycin would be used. 

Before you start any treatment, you should read the manufacturers leaflet contained with the medication. This has further information and lists the potential side effects.

Take one capsule three times a day, and space out the doses evenly during the day. Swallow the capsule with water, and you can take Amoxicillin either before, during or after your meals.

Do not take Amoxicillin if you are allergic to Penicillin.

Possible side effects to Amoxicillin

Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then speak with your doctor or pharmacist. 

The most common ones for Amoxicillin include:

  • feeling sick (nausea) or vomiting
  • diarrhoea
  • redness and itching in the mouth or vagina (thrush)
  • a skin rash
Information about Doxycycline

Doxycycline is an antibiotic that can be used to treat respiratory tract infections if you are allergic to penicillins. Take doxycycline with plenty of water while standing or sitting up to stop the capsules from causing any irritation to your throat. Do not lie down for at least thirty minutes after taking Doxycycline capsules, to allow the capsule to move quickly into the stomach and prevent irritation of the throat or food pipe. 

Take doxycycline with milk or a meal if you have an upset stomach.

Keep taking the Doxycycline until the full course is finished (unless a doctor tells you to stop), even if you feel that the infection has cleared up as it may return. If you forget to take a dose, take one as soon as you remember unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Avoid indigestion remedies, or supplements containing iron, magnesium, or zinc at the same time as doxycycline (from 2 hours before to 2 hours after taking doxycycline) as they stop the antibiotic from working properly.

Avoid drinking any alcohol as it may make the antibiotic less effective.

If you suffer from visual disturbances such as blurring of vision while taking Doxycycline, then do not drive or use machines.

Never give your medication to other people even if their condition appears to be the same as yours.

 

Possible side effects to Doxycycline

Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then speak with your doctor or pharmacist.

Doxycycline may cause your skin to become more sensitive to sunlight than usual. Avoid strong sunlight and do not use sunbeds. Use a sun cream with a high sun protection factor on bright days, even when it is cloudy. If you develop skin redness then speak to your doctor or pharmacist as soon as possible. 

Other side effects include:

  • diarrhoea
  • abdominal symptoms: upset tummy, indigestion or abdominal pain
  • headaches
  • thrush
  • dry mouth, throat irritation
  • sweating or feeling anxious
Information about Clarithromycin

Clarithromycin is sometimes prescribed for a respiratory tract infection, it is used if you have an allergy to penicillins.

Always read the manufacturers leaflet contained with the medication. This contains more information and lists all the potential side effects.

The dose is to be taken twice a day. It is important that you space out the doses evenly during the day. Swallow the tablet with water and you can take it either before or after food.

Keep taking Clarithromycin until the full course is finished (unless a doctor tells you to stop), even if you feel that the infection has cleared up. This is to stop the infection from coming back. If you forget to take a dose, take one as soon as you remember unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Possible side effects to Clarithromycin

Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then contact us, or speak with your doctor or pharmacist. 

The most common ones (occur in about 1 in 10 people) for Clarithromycin include:

  • feeling sick (nausea) or vomiting
  • diarrhoea
  • redness and itching in the mouth or genital area (thrush)
  • tooth or tongue discolouration, and changes in the way things taste or smell. This will settle once you finish treatment
  • a headache
Who should not take Clarithromycin

It is important that you tell your doctor in your assessment of all the medical conditions you have, and all the medications you take. Failure to do so can lead to problems with any treatment you are prescribed. Always read the patient leaflet before you take any medication. 

The following groups of people should not take Clarithromycin:

  • those allergic to clarithromycin or macrolide antibiotics
  • those with QT prolongation or ventricular cardiac arrhythmia, including torsades de pointe
  • those with heart disease
  • those with hypokalaemia (low potassium)
  • those with problems with the way your liver works
  • pregnant women or if breastfeeding 

The following medications can interact with Clarithromycin:

  • Statin for lowering cholesterol: you should stop your statin while you are taking Clarithromycin.
  • Colchicine used for gout: clarithromycin should not be taken if you are also taking colchicine. 
  • Warfarin: Clarithromycin can increase the bleeding risk
  • Ergotamine or dihydroergotamine used for migraines: Clarithromycin must not be taken with them
  • Sildenafil, tadalafil or vardenafil: Clarithromycin can increase the levels of the erectile dysfunction (ED) medication in the body. Consider reducing the dose of the ED medication while taking Clarithromycin. 
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 investigations.

  • If your cough has lasted longer than 3 weeks.
  • Coughing up blood.
  • If you have shortness of breath.
  • Any unexplained weight loss.
  • If you have night sweats.

If you develop any of the symptoms listed below, then you must seek urgent medical advice immediately. This can be from your GP, Out of Hours Service, Urgent care centre, Walk-in Centre, NHS 111. Call an ambulance or go to A&E if your symptoms are severe.

  • difficulty in breathing
  • chest pain
  • a severe headache
  • drowsiness or confusion
  • persistent vomiting
  • neck stiffness
  • non-blanching rash

How to find NHS services near you

In an emergency call 999 for immediate help for life-threatening conditions.

During working hours you can contact your GP surgery for help or call NHS 111. Alternatively, the following links can help you find Urgent Care Centres or Out of Hours care near you:


England 

Website: NHS Choices or telephone NHS 111


Wales

Website: NHS Direct Wales or telephone NHS Direct Wales on 0845 46 47 or the new 111 Wales Service for Swansea Neath Bridgend & Carmarthen


Scotland

Website: NHS Inform  or call NHS 111


Northern Ireland

Website: Health and Social Care

The contact telephone numbers for out of hours GP services in your area can be found here: NI Direct Government Services

Allergic reaction to medications

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

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

If you develop a sudden onset of any of the symptoms below then you must STOP the medication immediately and seek urgent medical advice. This could be from your GP, Out of Hours Service, Urgent Care Centre or NHS 111. Call an ambulance or go to A&E if the symptoms are severe.

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

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

  1. British Thoracic Society (BTS) guideline Recommendations for the management of cough in adults[Morice et al, 2006]
  2. American College of Chest Physicians (ACCP) guideline An empiric integrative approach to the management of cough. [Pratter et al, 2006]
  3. National Institute for Health and Care Excellence (NICE) guideline Respiratory tract infections (self-limiting): prescribing antibiotics
  4. Institute for Clinical Systems Improvement guideline Diagnosis and Treatment of Respiratory Illness in Children and Adults (ICSI,2013)

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Please read all the information about Cough first.