Is Teslon (generic name not specified) effective for treating upper respiratory tract infection (URTI) cough?

Teslon (Benzonatate) for Upper Respiratory Tract Infection Cough

Teslon (benzonatate) shows mixed evidence for URTI cough, with some studies demonstrating modest benefit while others show no significant effect, but it can be offered for short-term symptomatic relief when cough is dry and bothersome, particularly at night. 1

Evidence for Benzonatate in Acute Respiratory Infections

The ACCP guidelines reviewed multiple trials of benzonatate (Teslon) for acute bronchitis-related cough with inconsistent results: 1

• One study (1986, n=52) showed benzonatate 333 mg three times daily significantly improved cough symptoms on days 3,5, and 6 (p<0.05) 1
• Two other studies found no significant difference between benzonatate and placebo for cough frequency or symptoms 1
• A 1996 trial (n=91) using 250 mg four times daily showed no significant reduction in cough frequency 1

Current Guideline Recommendations

The ACCP recommends that antitussive agents (including benzonatate) are occasionally useful and can be offered for short-term symptomatic relief of coughing in acute bronchitis (Grade C recommendation, fair quality evidence, small/weak benefit). 1

However, more recent evidence suggests alternative first-line options:

• Inhaled ipratropium bromide is the preferred first-line treatment for persistent post-URI cough, with substantial benefit and Grade A recommendation 2
• Dextromethorphan and codeine are recommended only for dry, bothersome cough that disrupts sleep (Grade C1 recommendation) 1, 3

What NOT to Use

The following are explicitly not recommended for URTI cough: 1, 2, 3

• Expectorants, mucolytics, and antihistamines (Grade A1 - do not prescribe) 1
• Central cough suppressants like dextromethorphan have limited efficacy for URI-related cough (Grade D) 2
• Over-the-counter combination cold medications lack proven effectiveness 2

Clinical Algorithm for URTI Cough Management

For dry, bothersome cough (especially disrupting sleep):

1. First choice: Inhaled ipratropium bromide 2
2. Alternative: Benzonatate 100-200 mg three times daily for short-term relief 1
3. Consider: Dextromethorphan or codeine if ipratropium unavailable 1, 3

For productive cough with sputum:

• Do NOT suppress cough - it serves a physiological function to clear mucus 1
• Avoid antitussives in this scenario 1

Important Caveats

• Benzonatate should only be used for short-term symptomatic relief, not as definitive treatment 1, 2
• Rule out pneumonia, asthma, or COPD exacerbation before treating as simple URTI 2, 3
• Most URTI episodes are self-limiting and last 1-3 weeks without treatment 1
• The evidence quality for benzonatate is fair with small/weak benefit - consider this when weighing treatment options 1