Antibiotics for an acute cough can be considered either for immediate use or as a back-up if there is a higher risk of complications. This includes people with a pre-existing co-morbidity, young children who were born prematurely and older people meeting certain criteria. This means patients aged 65-80 years with two of the following, or patients aged over 80 with one of the following:

·       a hospital admission within the past year

·       diabetes (type 1 or 2)

·       congestive heart failure

·       current use of oral corticosteroids.9,12

If a patient is systemically very unwell with an acute cough, then an immediate antibiotic is recommended.

If antibiotic prescribing is to be based on C-reactive protein (CRP) testing, the test result should be used as follows:17

·       <20 mg/L - do not routinely offer antibiotics

·       20–100 mg/L - consider a delayed antibiotic prescription

·       >100 mg/L - offer antibiotic therapy.

The initial course of antibiotics should be for 5 days. The first-line choice in adults is doxycycline, with the second choice being from amoxicillin, clarithromycin or erythromycin. For children and teenagers under 8 years, the first choice is amoxicillin, otherwise select from clarithromycin, erythromycin or doxycycline.12