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GPs advised to avoid antibiotics for patients’ coughs

NICE recommends over-the-counter remedies first for coughs

Adrian O'Dowd

Friday, 24 August 2018

GPs should avoid prescribing antibiotics to patients with acute coughs and recommend they use honey or cough medicines first, according to new draft guidance.

The guidance by NICE developed with Public Health England (PHE) says antibiotics should not be issued as a first line treatment for a cough.

Instead, honey and over-the-counter remedies should be a patient’s first point of call to treat a cough and patients can speak to their GP if it persists for longer than three weeks.

NICE said that in most cases, acute coughs were caused by a cold or flu virus, or bronchitis, and lasted around three weeks, so clinicians should not offer antibiotics as they would make little difference to a person’s symptoms.

The draft guideline is part of a suite of antimicrobial prescribing guidance developed with PHE to help manage common infections and prevent antimicrobial resistance.

NICE said self-care products that people could take to manage their symptoms themselves included honey and cough medicines containing pelargonium, guaifenesin or dextromethorphan, for which there was some evidence of benefit for the relief of cough symptoms.

The guidance states it is important the reasons for not giving an antibiotic are clearly explained by the healthcare professional and advice is given to the patient on appropriate self-care.

An antibiotic could be necessary for acute cough when a person had been identified as being systematically unwell or if they were at risk of further complications for example, people with a pre-existing condition such as lung disease, immunosuppression or cystic fibrosis.

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

Dr Susan Hopkins, healthcare-associated infection and antimicrobial resistance deputy director at Public Health England, said: “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.”

Professor Mark Baker, director of the centre for guidelines at NICE said: “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.”

The guideline consultation closes on 20 September.

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