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Antibiotics should not be first line treatment for cough says NICE and PHE

Healthcare professionals are reminded that antibiotics should not be used as the first line of treatment for coughs, by NICE and Public Health England in new antimicrobial prescribing draft guidance.

The new guidance supports clinicians to reduce antibiotic prescriptions.  It says patients with acute cough should be given an explanation about why antibiotics are unlikely to reduce their symptoms and advice about self-care.

Self-care could include taking honey and medicines containing pelargonium, guaifenesin or dextromethorphan. There is some ‘limited’ evidence that these remedies and medicines may relieve cough symptoms, says NICE.

The draft guidance recommends:

  • Don't give antibiotics for acute cough unless there are systemic features of infection and/or other risk factors present such as chronic lung or heart disease
  • Don't give delayed antibiotics unless there are other risk factors present
  • Do give antibiotics if there are systemic features of infection
  • Give doxycycline as the first line antibiotic for adults with acute cough

Dr Kevin Gruffydd-Jones, PCRS policy advisor, says: “In general this guideline is welcome in highlighting the need not to over prescribe antibiotics for acute cough. However we will be responding to the consultation pointing out that it does provide conflicting advice with other NICE guidelines regarding doxycycline as the first line use of antibiotics in adults.”

The guideline is out for consultation until September 20.

What you can do;
Update your knowledge of antibiotics and respiratory tract infections by reading this Primary Care Respiratory Update article about a new clinical prediction tool that may help cut unnecessary antibiotic prescribing for children with coughs and respiratory tract infections.  

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