What alternative treatments are recommended for a worsening cough despite 4 days of Augmentin (amoxicillin/clavulanate) treatment for a head cold?

From the Guidelines

For a worsening cough despite 4 days of Augmentin treatment for a head cold, the most effective alternative treatment is to switch to supportive care with over-the-counter medications, as the current antibiotic regimen may not be effective against the underlying cause of the cough. Given the findings of the study by Llor et al 1, which showed no significant differences in the number of days with cough between patients treated with amoxicillin-clavulanic acid, ibuprofen, or placebo, it is likely that the cough is not responding to the antibiotic treatment. Some key points to consider in managing the worsening cough include:

• The use of ibuprofen, as studied by Llor et al 1, which may help alleviate symptoms, but its effectiveness in reducing cough duration is comparable to placebo.
• The potential for the cough to be viral in nature, in which case supportive care with medications such as guaifenesin to thin mucus, dextromethorphan for cough suppression, and honey for soothing irritation may be more appropriate.
• The importance of staying hydrated, using a humidifier, and getting adequate rest to help alleviate symptoms.
• The need for immediate medical evaluation if symptoms continue to worsen, especially if accompanied by high fever, chest pain, or difficulty breathing, as this could indicate pneumonia or other serious complications requiring different treatment approaches. It is also worth noting that the study by Llor et al 1 excluded the efficacy and safety of herbal and complementary therapies for cough in acute bronchitis, and another study 1 discussed the management of cough in adults, including intensive acid suppression with proton pump inhibitors and alginates, but these findings may not be directly applicable to the current scenario.

From the Research

Alternative Treatments for Worsening Cough

• Despite 4 days of Augmentin treatment, the cough is worsening, which may indicate the need for alternative treatments or further evaluation 2, 3.
• The initial treatment with Augmentin (amoxicillin/clavulanate) is a common approach for community-acquired respiratory tract infections, including those causing head colds and coughs 2.
• However, if the cough persists or worsens, other potential causes should be considered, such as upper airway cough syndrome, gastroesophageal reflux disease, asthma, or nonasthmatic eosinophilic bronchitis 3, 4.

Evaluation and Management of Chronic Cough

• Chronic cough is defined as a cough lasting longer than 8 weeks in adults and 4 weeks in children 3, 4.
• Evaluation should include cost-effective diagnostic tests, such as chest radiography and spirometry, and empiric and targeted treatment for the most common etiologies 3, 4.
• Patients with refractory chronic cough may warrant referral to a pulmonologist or otolaryngologist and consideration of alternative treatments, such as gabapentin, pregabalin, or speech therapy 3, 4.

Cough Augmentation Techniques

• Cough augmentation techniques, such as assisted inspiration, assisted expiration, and their combination, may be considered for patients with weak and ineffective cough 5.
• These techniques aim to assist or simulate the cough maneuver and can generate higher cough peak flows compared to unassisted cough 5.
• However, the effectiveness and safety of cough augmentation techniques require further evaluation, and current evidence is limited by considerable limitations and challenges in comparing different techniques 5.