Updated 17 September 2018

What should be your first-line treatment for a cough?

Are antibiotics your first port of call when you have a nagging cough? New guidelines suggest that we should explore other options.

According to recent guidelines, natural remedies such as honey and over-the-counter remedies are better than antibiotics for treating a cough.

Health officials say that antibiotics shouldn’t be prescribed by doctors for coughs, as they rarely kill the virus and do little to ease the symptoms. Overuse of antibiotics is also a major cause of the growing problem of antibiotic resistance.

Honey is a well-known remedy

According to the National Institute for Health and Care Excellence (NICE) and Public Health England (PHE), there is some evidence that natural remedies, such as a hot drink with honey, lemon and ginger, can be more effective for a cough and sore throat than antibiotics.

Over-the-counter cough medicines containing pelargonium, guaifenesin or dextromethorphan should also be used first. Patients should wait and see if this clears up the cough before trying anything else.

Mark Baker, director of the NICE said in a statement, “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.”

It is important to note that these recommendations are only for acute coughs that eventually go away on their own.

People are also warned to not use honey in children younger than a year old as it may contain bacteria that can cause infant botulism.

Why these guidelines?

According to the World Health Organization (WHO), antibiotic resistance is one of the biggest threats to global health, food security and development. It happens naturally, but is amplified by the overuse of antibiotics in humans.

Antibiotic resistance is becoming dangerously high all over the world, and a growing list of infections are becoming harder to treat as antibiotics become less effective.

It is important for people to realise that antibiotics aren't necessary to treat a cough, and that there are many alternatives that can help ease their symptoms.

But don’t forget about your doctor

This does, however, not mean you should continue using home remedies when your symptoms persist. If your cough doesn’t go away on its own, it’s important to get your doctor to help establish the cause of your chronic cough.

There are various reasons why a cough persists, and by ignoring it you could be ignoring a serious underlying problem. Be sure to go the doctor if you:

  • Cough up blood
  • Are losing weight
  • Are struggling to breathe
  • Have been coughing for more than a couple of weeks
  • Have an ongoing fever

Not sure when to consult your doctor or what type of cough you have? Use Health24's checklist.

“If a cough is getting worse rather than better, or the person feels very unwell or breathless, they need to contact their GP,” says Dr Tessa Lewis, chair of the antimicrobial prescribing guideline group.

Treat your cough at home

A previous Health24 article gives the following guidelines to treat a cough at home:

  • For a productive (wet) cough, mucolytic medications like N-Acetylcysteine (NAC) are important, as they are specifically designed to break down the mucus that is causing the cough.
  • Mucolytics have been shown to assist in reducing cough in adults and children.
  • Take half a teaspoon of honey before going to bed.
  • Sucking lozenges or sipping water may temporarily suppress a cough and relieve throat irritation.

Image credit: iStock


Ask the Expert

Cough Expert

Professor Keertan Dheda has received several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others. Read his full biography at the University of Cape Town Lung Institute.

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