NICE recommendations on antibiotic prescribing for acute cough

NICE has published new recommendations on antimicrobial prescribing for acute cough. It says that acute cough is usually self-limiting and resolves within 3 to 4 weeks without antibiotics. The most common cause is a viral upper respiratory tract infection. Acute bronchitis, a lower respiratory tract infection can also cause acute cough.

The guideline advises that medical help should be sought if symptoms worsen rapidly or significantly, do not improve after 3 to 4 weeks, or the person becomes systemically very unwell.

Some Key recommendations are:

  • A mucolytic or an oral/inhaled bronchodilator or an oral/inhaled corticosteroid should not be offered to people for an acute cough associated with an URTI or acute bronchitis unless the person has an underlying airways disease, such as asthma.
  • Do not offer an antibiotic to treat an acute cough associated with an URTI or acute bronchitis in people who are not systemically very unwell or at higher risk of complications. Give advice about why an antibiotic is not needed
  • People with a pre-existing comorbidity, young children born prematurely, people ≥ 65 years with ≥2 of the following, or > 80 years with ≥ 1of the following (hospitalization in previous year, type 1 or type 2 diabetes, history of congestive heart failure, current use of oral corticosteroids) are at greater risk of complications.
  • People with acute cough who are systemically very unwell or at higher risk of complications should be offered an immediate antibiotic prescription.
  • Consider either an immediate antibiotic prescription or a back-up antibiotic prescription for people with an acute cough who are identified at a face-to-face clinical examination as at higher risk of complications.
  • When no antibiotic prescription is given, give advice about why an antibiotic is not needed.
  • If an immediate antibiotic prescription is given, advice about possible adverse effects of the antibiotic (diarrhea and nausea).
  • When a back-up antibiotic prescription is given, give advice about an antibiotic not being needed immediately and also about using the back-up prescription if symptoms worsen rapidly or significantly at any time.
  • Refer to hospital, or seek specialist advice on further investigation and management, if the person has any symptoms or signs suggesting a more serious illness or condition (for example, sepsis, a pulmonary embolism or lung cancer)

(Source: Cough (acute): antimicrobial prescribing, NICE guideline [NG120] Published date: February 2019)

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