Don't use Antibiotics as first line of treatment of cough, says NICE

A new draft guidance issued by NICE and PHE reports that honey and over-the-counter remedies should be a patient’s first line of treatment for a cough and not antibiotics.

The guidance says that patients suffering from coughs that have lasted around three weeks most likely caused by a cold or flu virus or bronchitis should not be prescribed antibiotics as they ‘make little difference’ to symptoms.

In most cases, acute coughs are caused by a cold or flu virus, or bronchitis, and last around three weeks. The guideline has advised the clinicians not to offer antibiotics in most cases.

Dr. Tessa Lewis, GP, and chair of the NICE antimicrobial prescribing guideline group said: "If someone has a runny nose, sore throat and cough we would expect a cough to settle over 2 -3 weeks and antibiotics are not needed.

“People can check their symptoms on NHS choices or NHS Direct Wales or ask their pharmacist for advice.

“If a cough is getting worse rather than better or the person feels very unwell or breathless then they would need to contact their GP."

The guidance reads: ‘Promoting the role of self-care may help to reduce the number of antibiotic prescriptions, and repeated or future consultations in general practice.’

Honey and cough medicines containing pelargonium, guaifenesin or dextromethorphan have some evidence of benefit for the relief of cough symptoms but honey should not be given to infants under 12 months because of the risk of botulism.

According to Dr. Susan Hopkins, healthcare-associated infection and antimicrobial resistance deputy director at Public Health England, “Antibiotic resistance is a huge problem and we need to take action now to reduce antibiotic use. Taking antibiotics when you don’t need them puts you and your family at risk of developing infections which in turn cannot be easily treated.’

“These new guidelines will support GPs to reduce antibiotic prescriptions and we encourage patients to take their GPs advice about self-care,” he added.

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Professor Mark Baker, director of the center for guidelines at NICE said: “We are keen to highlight that in most cases, antibiotics will not be necessary to treat a cough. We want people to be offered advice on alternatives that may help ease their symptoms."

“When prescribing antibiotics, it is essential to take into account the benefit to the patient and wider implications of antimicrobial resistance, only offering them to people who really need them.

“This guideline gives health professionals and patients the information they need to make good choices about the use of antibiotics. We encourage their use only when a person is at risk of further complications.”

As per the new guideline, an antibiotic may be necessary for an acute cough when a person has been identified as being systematically unwell or if they are at risk of further complications, for example, people with a pre-existing condition such as lung disease, immunosuppression or cystic fibrosis.