What is the role of antibiotics in the management of acute cough in adults with no signs of pneumonia?

Role of antibiotics in acute cough management without pneumonia:

Antibiotics are generally not routinely recommended for adults presenting with an acute cough when there are no signs of pneumonia or systemic severe illness. Instead, management focuses on symptomatic treatment and self-care advice.

Antibiotic prescribing should be guided by clinical assessment and, if available, C-reactive protein (CRP) testing: if CRP is less than 20 mg/L, antibiotics should not be routinely offered; if CRP is between 20 and 100 mg/L, a delayed antibiotic prescription may be considered; and if CRP is greater than 100 mg/L, antibiotic therapy should be offered.

Immediate antibiotic treatment is reserved for those who are systemically very unwell or at higher risk of complications due to comorbidities or age.

When antibiotics are indicated, doxycycline is the first-line choice for adults (excluding pregnant women), with a 5-day course recommended to minimize resistance risk. Alternatives include amoxicillin, clarithromycin, or erythromycin depending on patient factors such as pregnancy.

Oral or inhaled bronchodilators, corticosteroids, and mucolytics are not recommended for acute cough associated with bronchitis unless there is an underlying airway disease.