New NICE guideline on the management of acute cough

  • National Institute of Health and Care Excellence

  • curated by Dawn O'Shea
  • UK Medical News
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NICE has published a new guideline which sets out an antimicrobial prescribing strategy for acute cough associated with upper respiratory tract infection (URTI) or acute bronchitis in adults, young people and children. The guideline aims to limit antibiotic use and reduce antibiotic resistance.

The guidelines stress that patients with acute cough associated with URTI or acute bronchitis should not be offered an oral or inhaled bronchodilator or corticosteroid, in the absence of underlying airway disease. Mucolytics should not be prescribed.

When an antibiotic is deemed appropriate, the first-line agent of choice for adults is doxycycline 200 mg on first day, then 100 mg once daily for 4 days. Alternative first choices are 5-day courses of amoxicillin 500 mg three times daily (tds), clarithromycin 250-500 mg twice daily (bd) or erythromycin 250-500 mg four times (qds) or 500-1000 mg bd.

In patients aged less than 18 years, amoxicillin is the treatment of choice. Recommended doses are 125 mg tds in infants aged 1-11 months, 250 mg tds in 1-4 year olds, and 500 mg tds in 5-17 year olds, all for 5 days.

Alternative first choices are:

1. Clarithromycin

  • Under 8 kg: 7.5 mg/kg bd for 5 days
  • 8-11 kg: 62.5 mg bd for 5 days
  • 12-19 kg: 125 mg bd for 5 days
  • 20-29 kg: 187.5 mg bd for 5 days
  • 30-40 kg: 250 mg bd for 5 days
  • 12-17 years, 250-500 mg bd for 5 days

2. Erythromycin

  • 1 month to 1 year: 125 mg qds or 250 mg bd for 5 days
  • 2-7 years: 25 mg qds or 500 mg bd for 5 days
  • 8-17 years: 250-500 mg qds or 500-1000 mg bd for 5 days

3. Doxycycline

  • 12-17 years: 200 mg on first day, then 100 mg once daily for 4 days

The full guideline is available here.

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