What is the appropriate treatment for a 15-year-old male presenting with a cough?

Treatment of Cough in a 15-Year-Old Male

For a 15-year-old male presenting with cough, the initial approach should be a "watch, wait, and review" strategy, as most cases represent post-viral cough or acute bronchitis that will resolve without specific intervention. 1, 2

Initial Assessment

• Determine the duration of cough to guide management: acute (<3 weeks), subacute (3-8 weeks), or chronic (>8 weeks) 1
• Assess for red flags that suggest serious conditions requiring immediate attention:
  • Hemoptysis
  • Prominent dyspnea (especially at rest or night)
  • Fever
  • Abnormal respiratory exam findings 1
• Evaluate vital signs (heart rate, respiratory rate) to rule out pneumonia or other serious conditions 3

Management Algorithm Based on Cough Duration

For Acute Cough (<3 weeks) - Most Likely Scenario

• First-line treatment recommendations:

  • Adequate fluid intake (up to 2 liters per day) to prevent dehydration 2
  • Honey for cough suppression (patient is over 1 year of age) 2
  • Dextromethorphan can be used as a cough suppressant if needed 4
  • First-generation antihistamine/decongestant combination if upper airway cough syndrome is suspected 2
  • Paracetamol for fever and associated symptoms if present 2

• Avoid unnecessary antibiotics for uncomplicated acute bronchitis with productive cough, as they show no significant benefit in cough resolution 3

For Subacute Cough (3-8 weeks)

• Determine if the cough is postinfectious (48.4% of cases) or non-infectious 1, 5
• For postinfectious cough:
  • Consider treatment for upper airway cough syndrome with first-generation antihistamine/decongestant 5
  • If bronchial hyperresponsiveness is suspected, consider inhaled bronchodilators and inhaled corticosteroids 5

For Chronic Cough (>8 weeks)

• Sequential and additive treatment approach for common causes:
  • Upper airway cough syndrome: first-generation antihistamine/decongestant 1
  • Asthma: inhaled corticosteroids and bronchodilators 1, 6
  • Non-asthmatic eosinophilic bronchitis: inhaled corticosteroids 1, 6

Special Considerations for Adolescents

• For dry cough persisting beyond 1-2 weeks, consider inhaled corticosteroids (400μg/day budesonide equivalent) 1
• For wet/productive cough persisting beyond 1-2 weeks, consider antimicrobials (10 days) 1
• Evaluate for environmental triggers (tobacco smoke, allergens) that may exacerbate cough 1

Follow-up Recommendations

• Review in 1-2 weeks if symptoms persist 1
• If cough persists beyond 3 weeks, reassess and consider additional evaluation 3
• Routinely assess cough severity or quality of life before and after treatment 1

Common Pitfalls to Avoid

• Don't rely solely on cough characteristics for diagnosis, as they have limited diagnostic value 1, 7
• Avoid using newer generation non-sedating antihistamines for cough associated with common cold as they are ineffective 2
• Don't prescribe antibiotics based solely on the presence of productive cough or purulent sputum 3
• Avoid combination cough preparations without identifying the specific cause 8

Remember that in adolescents, the most common causes of persistent cough include asthma (15.8%), upper airway cough syndrome (33.2%), and postinfectious cough (48.4%) 1, 5.