From the Guidelines
For treating post-infectious cough in pediatrics, the primary recommendation is supportive care and time, as most cases resolve on their own within 2-3 weeks. Specific treatments include:
- Honey: 2.5-10 mL (depending on age) given 1-2 times daily for children over 1 year old.
- Hydration: Encourage increased fluid intake.
- Humidification: Use a cool-mist humidifier in the child's room.
- Nasal saline drops: 2-3 drops in each nostril before feeding and sleep. For persistent coughs lasting over 4 weeks, consider:
- Inhaled corticosteroids: e.g., Fluticasone 50-100 mcg twice daily for 2-4 weeks for children over 4 years old.
- Montelukast: 4 mg daily for children 2-5 years, 5 mg daily for 6-14 years, for 2-4 weeks. Avoid over-the-counter cough suppressants in children under 6 years due to potential side effects and limited efficacy, as suggested by 1. These treatments work by soothing irritated airways (honey), reducing inflammation (corticosteroids), or modulating the immune response (montelukast). The focus is on managing symptoms while the body naturally recovers from the infection. Always reassess if symptoms persist or worsen, as this may indicate a different underlying condition requiring further evaluation, as recommended by 1.
In terms of specific guidance, the 2017 study 1 provides a comprehensive approach to managing chronic cough in children, emphasizing the importance of a systematic approach to determining the cause of the cough and basing management on the etiology of the cough. This study also highlights the need to consider pediatric-specific issues and the risk-benefit ratio when undertaking investigations in children.
It's also important to note that, according to 1, the use of antibiotics has no role in the treatment of post-infectious cough, except for bacterial sinusitis or early on in a B pertussis infection. Inhaled ipratropium may be helpful in some cases, and other causes of post-infectious cough, such as persistent inflammation of the nose and paranasal sinuses, or gastroesophageal reflux disease, should be considered and managed accordingly.
Overall, the management of post-infectious cough in pediatrics should prioritize supportive care, symptom management, and a systematic approach to determining the underlying cause of the cough, as recommended by the most recent and highest quality study 1.
From the FDA Drug Label
Purpose Cough suppressant The treatment options for post-infectious cough in Pediatrics include:
- Cough suppressant medication, such as dextromethorphan (PO) 2 Note that the FDA label does not provide a comprehensive list of treatment options, and dextromethorphan is only mentioned as a cough suppressant.
From the Research
Treatment Options for Post-Infectious Cough in Pediatrics
The treatment of post-infectious cough in pediatrics should be based on the etiology of the cough 3. The following are some treatment options:
- For acute post-viral cough, levodropropizine may be an effective and safe choice 4
- For chronic cough, a multidisciplinary team approach consisting of pulmonologists, gastroenterologists, allergists, immunologists, and otolaryngologists may be necessary to determine the underlying cause and develop a treatment plan 5
- Empirical treatment based on the cough characteristics may be useful in some cases of nonspecific chronic cough 3
- There is no scientific evidence to justify the use of over-the-counter cough remedies, such as anti-tussives, mucolytics, and/or antihistamines, due to potentially serious side effects 3, 6
Considerations for Treatment
When managing post-infectious cough in children and adolescents, it is essential to consider the following:
- The cause of the cough is often elusive, and a thorough evaluation is necessary to determine the underlying cause 5
- Treatment should be specific to the diagnosis, and a multidisciplinary team approach may be necessary 5
- Non-pharmacological remedies may be safe, but few substances have a documented degree of efficacy 4
- The use of antitussive drugs, such as central or peripheral drugs, should be carefully considered due to potential side effects and abuse 4