Honey and over-the-counter remedies should be a patient’s first point of call to treat a cough, not antibiotics, says NICE and PHE in new draft guidance.

Clinicians are being advised in most cases not to offer antibiotics as they make little difference to a person’s symptoms.

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."

NICE says that honey and cough medicines containing pelargonium, guaifenesin or dextromethorphan have some evidence of benefit for the relief of cough symptoms.

The draft guidance states it is important the reasons for not giving an antibiotic are clearly explained by the healthcare professional and advice is given to the patient on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

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: “We are keen to highlight that in most cases, antibiotics will not be necessary to treat a cough. We want people to be offered advice on alternatives that may help ease their symptoms.

“When prescribing antibiotics, it is essential to take into account the benefit to the patient and wider implications of antimicrobial resistance, only offering them to people who really need them.

“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.”

This draft guideline is part of a suite of antimicrobial prescribing guidance developed with Public Health England to help manage common infections and prevent antimicrobial resistance. 

The consultation for this acute cough guideline closes on the 20 September 2018.

In response to the new guidance, Donna Castle, PAGB Director of Public Affairs said, “It is encouraging that NICE draft guidance recommends that unless they have a pre-existing lung condition, adults with an acute cough should be advised to self care and use over-the-counter (OTC) cough products, rather than seeking a GP’s prescription. OTC medicines play an important role in helping people manage symptoms of self-treatable conditions.
 
“It’s important to remember that cough medicines will not ‘cure’ a cough. If used in accordance with the instructions on the packaging and in the patient information leaflet, then cough medicines are an appropriately safe way to help relieve the disruptive symptoms of a cough so people can get on with their day.
 
“The key to effective management of a cough is to identify the most troublesome symptom and to choose an appropriate product to treat it. The pharmacy should be the first port of call for people who are looking for advice on how to manage their cough symptoms. Pharmacists are expert healthcare professionals who can give advice on the most suitable medicine to take if people are unsure, or signpost people if they need further guidance.
 
“PAGB believes it is important to empower people to self care for self-treatable conditions, like coughs, to help to reduce unnecessary pressure on overstretched NHS services, ensuring people are seen by the right healthcare professional at the right time. PAGB is calling for a national strategy for self care, to help ensure a sustainable future for our healthcare system, by enhancing access to self care, improving health literacy and realising the potential of pharmacists.”

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