What is the recommended treatment for an acute cough, specifically a cough suppressant?

From the Guidelines

For an acute cough, dextromethorphan is the recommended over-the-counter cough suppressant for adults and children over 4 years old. The typical adult dose is 10-30 mg every 4-8 hours, not exceeding 120 mg in 24 hours, as suggested by guidelines for managing adult lower respiratory tract infections 1. For children 4-12 years, the dose should be adjusted based on weight or age according to package instructions. Dextromethorphan works by suppressing the cough reflex in the brain, making it effective for dry, non-productive coughs that interfere with sleep or daily activities. It's best taken at bedtime or when the cough is most bothersome. Some key points to consider when treating an acute cough include:

• Honey (1 teaspoon) can be an effective natural alternative for children over 1 year old, as it may offer more relief for cough symptoms than no treatment, diphenhydramine, or placebo, although it is not better than dextromethorphan 1.
• For productive coughs with phlegm, cough suppressants should generally be avoided as coughing helps clear secretions.
• Most acute coughs resolve within 1-2 weeks without treatment.
• If the cough persists beyond 2 weeks, is accompanied by fever over 101°F, shortness of breath, or bloody mucus, medical attention should be sought as these may indicate a more serious condition requiring different treatment.

From the FDA Drug Label

Uses temporarily relieves cough due to minor throat and bronchial irritation as may occur with a cold controls cough to help you sleep Purpose Cough suppressant Antihistamine The recommended cough suppressant for an acute cough is dextromethorphan (PO), which is used to temporarily relieve cough due to minor throat and bronchial irritation, such as those that occur with a cold 2 2.

• Key uses: temporarily relieves cough, controls cough to help you sleep
• Mechanism: cough suppressant The treatment is intended for minor throat and bronchial irritation, such as those associated with a cold or upper respiratory allergies 2.

From the Research

Cough Suppressant Treatment

The recommended treatment for an acute cough, specifically a cough suppressant, is a topic of ongoing research and debate.

• Dextromethorphan (DM) is a commonly used antitussive, but its efficacy is uncertain, and its use is not supported by the American Academy of Pediatrics 3.
• A study on the dose-response relationship of DM in children found that higher doses (0.45 to <0.60 mg/kg per dose) may provide more symptomatic relief, but also increase the risk of adverse events 3.
• Another study found that DM had little to no antitussive activity in patients with cough associated with acute upper respiratory tract infection 4.
• However, a more recent study found that DM was effective in reducing cough frequency and severity in children aged 6-11 years with acute cough due to the common cold 5.
• Codeine is also used as a cough suppressant, but a study found that it was no more effective than placebo in treating night cough in children 6.
• Antitussive preparations, such as combinations of codeine or DM with antihistamines, decongestants, and expectorants, are available for symptomatic relief of dry or non-productive cough 7.

Treatment Options

Treatment options for acute cough include:

• Dextromethorphan (DM) in various doses, with higher doses potentially providing more symptomatic relief but also increasing the risk of adverse events 3, 5.
• Codeine, which may be no more effective than placebo in treating night cough in children 6.
• Antitussive preparations, such as combinations of codeine or DM with antihistamines, decongestants, and expectorants, for symptomatic relief of dry or non-productive cough 7.
• First-generation antihistamines like chlorpheniramine and centrally acting opioid derivatives like codeine, which may be used alone or in combination for nonspecific cough 7.