acute cough (antimicrobial prescribing)

• Usually viral and self-limiting; the typical course is up to 3–4 weeks.
• Do not routinely offer antibiotics for uncomplicated acute cough, including acute bronchitis and URTI-related cough.
• Do not offer mucolytics, oral/inhaled bronchodilators, or oral/inhaled corticosteroids unless otherwise indicated.
• Reassess if symptoms worsen rapidly/significantly, persist beyond the expected course, or if red flags suggest pneumonia/PE/sepsis/lung cancer.

Consider an immediate antibiotic or a back-up prescription in people at higher risk of complications, such as:

• People with relevant comorbidity.
• Older adults: >65 with ≥2 risk factors or >80 with ≥1 risk factor (recent hospitalisation, diabetes, CHF history, current oral corticosteroids).
• Young children born prematurely (paediatric safety-netting).

Adults (18+):

• First choice: doxycycline 200 mg on day 1, then 100 mg OD for 4 days (5-day course total).
• Alternative first choices: amoxicillin 500 mg TDS for 5 days; clarithromycin 250–500 mg BD for 5 days; erythromycin 250–500 mg QDS or 500–1000 mg BD for 5 days.
• Pregnancy: amoxicillin is preferred; if a macrolide is needed, erythromycin is preferred.

Children (under 18): NICE provides age/weight-banded amoxicillin and macrolide doses, and doxycycline for ages 12–17. Use the NICE table and BNF for Children for dosing in specific populations.

• Explain expected duration (up to 3–4 weeks) and why antibiotics don’t meaningfully shorten it for most people.
• Offer symptom care options (honey >1 year, selected OTC products) and clear safety-net advice (worsening breathlessness, chest pain, haemoptysis, new confusion, persistent fever, or deterioration).
• Where you use a back-up prescription, specify when to start it (rapid deterioration, significant worsening, or no improvement after a defined timeframe).