Recommended Treatment for Cough
For most acute coughs due to viral infections, simple home remedies like honey and lemon are recommended as first-line treatment, with dextromethorphan-containing over-the-counter medications as an effective option for symptom relief when needed. 1
Acute Cough Management (Duration < 3 weeks)
Most short-term coughs are caused by viral infections and are self-limiting. The treatment approach should follow this algorithm:
First-Line Options:
- Home remedies: Honey and lemon mixtures are recommended as the simplest and most cost-effective treatment 1
- Simple voluntary cough suppression: This can be sufficient to reduce cough frequency 1
- Adequate hydration: Helps thin secretions
Second-Line Options (if symptoms are distressing):
- Dextromethorphan-containing products: The most effective OTC cough suppressant 1, 2
- Menthol lozenges or vapor: Provides short-term cough suppression 1
- Sedating antihistamines: May be useful for nighttime cough but cause drowsiness 1
Not Recommended:
- Antibiotics: Ineffective for viral coughs and contribute to antibiotic resistance 2
- Codeine or pholcodine: No greater efficacy than dextromethorphan but have worse side effect profiles 1
When to Seek Medical Attention
Medical evaluation is necessary if any of these warning signs are present:
- Coughing up blood
- Breathlessness
- Prolonged fever and feeling unwell
- Pre-existing conditions (COPD, heart disease, diabetes, asthma)
- Recent hospitalization
- Symptoms persisting beyond three weeks 1
Special Considerations
Chronic Cough (> 8 weeks)
For persistent cough that doesn't respond to treatment of underlying causes, consider:
- Referral to specialist cough clinic for comprehensive evaluation 1
- Higher doses of dextromethorphan may be needed, balancing efficacy with side effects 4
- In refractory cases, other medications may be considered under specialist supervision 5
Caveats and Pitfalls
- Dosing considerations: Dextromethorphan dosing should be appropriate - underdosing may lead to treatment failure 4
- Combination products: Be cautious with combination cough medications that contain other ingredients like paracetamol, as higher doses may lead to toxicity 1
- Efficacy limitations: Even the most effective cough suppressants may provide only modest relief 6
- Lifestyle factors: Smoking cessation is crucial for those with persistent cough 1
The evidence for dextromethorphan's efficacy is somewhat mixed, with some studies showing significant benefit 3 while others show limited clinical effect 6. However, guidelines still recommend it as one of the most effective available options for symptomatic relief when needed 1, 2.