Why is my persistent cough not improving despite 4 days of amoxicillin (amoxicillin) therapy for symptoms of nasal congestion, earache, and deep cough lasting 8 days?

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Last updated: March 28, 2025View editorial policy

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From the Guidelines

You should consult with your healthcare provider as your symptoms may indicate that either the antibiotic isn't effective against your specific infection or you might have a viral infection rather than bacterial. Amoxicillin typically begins showing improvement within 48-72 hours for bacterial infections, so persistent symptoms after 4 days could mean the infection is resistant to this antibiotic or is viral in nature 1. Viral respiratory infections often cause symptoms lasting 7-10 days and won't respond to antibiotics. While continuing your prescribed medication unless told otherwise, you might benefit from supportive care like rest, staying hydrated, using saline nasal sprays, taking over-the-counter pain relievers, and using honey for cough (if over 1 year old). The combination of ear pain with respiratory symptoms could indicate complications like sinusitis or ear infection that might require different treatment, as a bacterial cause is more likely when symptoms persist for more than 10 days without clinical improvement 1. Your doctor might need to reassess your condition, possibly change your antibiotic, or add additional treatments based on your specific situation. Some key points to consider include:

  • The lack of improvement with amoxicillin may suggest a viral infection or resistance to the antibiotic 1.
  • Clinical guidelines recommend using clinical signs and symptoms to differentiate bacterial from viral causes, with a bacterial cause more likely in cases of persistent or severe symptoms 1.
  • Supportive care and potential changes to your treatment plan should be discussed with your healthcare provider to ensure the best possible outcome.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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