What is the recommended treatment for a viral cough?

Treatment for Viral Cough

For viral cough treatment, simple home remedies like honey and lemon are recommended as first-line therapy, with dextromethorphan being the most effective over-the-counter medication if additional symptom relief is needed. 1

First-Line Treatment Options

• Viral coughs are almost invariably benign and prescribed treatment can be regarded as unnecessary, though they can cause significant morbidity and distress 1
• Simple home remedies such as honey and lemon mixtures are the simplest, cheapest, and often effective first approach 1, 2
• Adequate hydration helps thin secretions and makes coughs more productive 2
• Simple voluntary suppression of cough may be sufficient to reduce cough frequency in many cases 1, 2
• Antibiotics are not helpful for viral coughs, even when phlegm is present 1, 3

Over-the-Counter Medications

Cough Suppressants

• Dextromethorphan is the preferred non-sedating antitussive with proven efficacy in meta-analyses 1, 4
• Maximum cough reflex suppression occurs at 60 mg with prolonged effect 1, 2
• Care must be taken with higher doses as some preparations contain other ingredients like paracetamol 1
• Do not use dextromethorphan if taking monoamine oxidase inhibitors (MAOIs) 4

Other Options

• Menthol by inhalation or in lozenges provides acute, short-lived cough suppression 1, 2
• First-generation antihistamines with sedative properties can suppress cough and may be particularly suitable for nocturnal cough 1, 5
• Guaifenesin may help loosen phlegm and thin bronchial secretions to make coughs more productive 6, though evidence is mixed 3, 7

Not Recommended

• Codeine or pholcodine have no greater efficacy than dextromethorphan but have a much greater adverse side effect profile (drowsiness, nausea, constipation) 1, 8
• Opiate antitussives are not recommended due to their significant adverse side effect profile 1

When to Seek Medical Attention

Consult a doctor if:

• You cough up blood 1
• You experience breathlessness 1
• You have prolonged fever and feel unwell 1
• You have a medical condition such as chronic bronchitis (COPD), heart disease, diabetes, or asthma 1
• You have recently been hospitalized 1
• Your symptoms persist for more than three weeks 1

Special Considerations for COVID-19

• For COVID-19 related cough, encourage patients to avoid lying on their back as this makes coughing ineffective 1
• Consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution only if cough is distressing in COVID-19 patients 1

Common Pitfalls and Caveats

• Using subtherapeutic doses of dextromethorphan may not provide adequate cough suppression 1, 5
• Green or yellow sputum suggests a possible bacterial infection in addition to a viral cause, and consulting a doctor is advisable 9
• Repeated coughs and colds with complaints of feeling "run down" may indicate poor diet; consider recommending vitamin supplements and dietary improvements 9
• For children, evidence for most over-the-counter cough medications is limited, and many studies show they are no more effective than placebo 3, 7

Remember that most viral coughs are self-limiting and will resolve without specific treatment, typically within 1-2 weeks 2, 10.