From the Guidelines
Cough in pneumonia is not effectively treated with nonantibiotic, symptomatic therapy.
Treatment Overview
- The current evidence suggests that there is insufficient evidence to confirm or refute the use of nonantibiotic, symptomatic therapy to treat outpatients with acute cough and suspected pneumonia 1.
- Various interventions have been explored, including cough suppressants, mucolytics, systemic corticosteroids, inhaled corticosteroids, anticholinergics, nonsteroidal antiinflammatory drugs, and vitamins C and D 1.
- However, a systematic review found only one RCT that compared the mucolytic bromhexine along with the antibiotic amoxicillin vs amoxicillin alone, and the combined treatment did not improve the outcome of cough not cured or not improved (OR, 1.21; 0.48-3.04) 1.
Clinical Recommendations
- For outpatient adults with acute cough due to suspected pneumonia, an assessment of clinical symptoms and signs, and chest radiography to improve diagnostic accuracy is recommended 1.
- Empiric antibiotics should be used when pneumonia is suspected based on epidemiologic and clinical features in settings in which imaging cannot be performed 1.
- However, there is insufficient evidence to make recommendations for or against specific nonantibiotic, symptomatic therapies 1.
From the Research
Treatment of Cough in Pneumonia
- Cough is a common symptom of pneumonia, and its treatment is often sought by patients 2, 3.
- Over-the-counter (OTC) cough medications, such as mucolytics or cough suppressants, may provide relief in reducing cough severity, but their use as an adjunct to antibiotics in pneumonia is not well established 2, 3.
- Studies have shown that mucolytics may be beneficial in reducing the secondary outcome of 'not cured' in patients with pneumonia, but the evidence is insufficient to recommend them as an adjunctive treatment 2, 3.
Use of Antibiotics in Pneumonia
- Antibiotics are often prescribed to patients with acute cough, but their use should be guided by clinical prediction rules to identify patients with pneumonia or combined viral-bacterial infection 4.
- The use of antibiotics in patients with pneumonia should be based on knowledge of local bacterial pathogens and their antibiotic susceptibility and resistance profiles 5.
- In patients with acute bronchitis, antibiotics are not indicated unless there is evidence of pneumonia or other secondary causes of cough 6.
Management of Cough in Pneumonia
- The management of cough in pneumonia should include symptomatic treatment, such as cough suppressants or expectorants, and avoidance of unnecessary antibiotic use 2, 3.
- Patients with pneumonia should be educated about the natural course of the disease and the potential benefits and risks of treatment options 6.
- Strategies to reduce inappropriate antibiotic use, such as delayed prescriptions and patient education, should be implemented in the management of cough in pneumonia 6.