What are the treatment options for acute cough caused by viral infections?

From the Guidelines

For treating cough from viral infections, focus on symptom management since antibiotics are ineffective against viruses. The most recent and highest quality study 1 suggests that management of viral rhinosinusitis (VRS) is primarily directed toward relief of symptoms, and palliative medications such as analgesics, anti-inflammatory agents, nasal saline, decongestants, antihistamines, mucolytics, cough suppressants, and topical or oral corticosteroids may be used alone or in varying combinations for symptom relief. Some key points to consider when treating cough from viral infections include:

• Over-the-counter medications like dextromethorphan (Robitussin DM, 10-20 mg every 4 hours) can suppress cough, while guaifenesin (Mucinex, 200-400 mg every 4 hours) helps thin mucus 1.
• Honey (1-2 teaspoons as needed) is effective for adults and children over age 1 1.
• Staying hydrated with warm fluids like tea with honey and lemon can help soothe irritated airways.
• Using a humidifier or taking steamy showers can help moisten air passages.
• For nighttime cough, try elevating your head with extra pillows. Most viral coughs resolve within 1-2 weeks without specific treatment. If the cough persists beyond 3 weeks, worsens significantly, produces discolored phlegm, or is accompanied by high fever, shortness of breath, or chest pain, seek medical attention as these may indicate complications or bacterial infection 1. Rest is important to support your immune system's fight against the viral infection.

From the FDA Drug Label

In both trials, there was a 1.3-day reduction in the median time to improvement in influenza-infected subjects who received oseltamivir phosphate 75 mg twice a day for 5 days compared to subjects who received placebo. Subjects were required to self-assess the influenza-associated symptoms (nasal congestion, sore throat, cough, aches, fatigue, headaches, and chills/sweats) twice daily as "none," "mild," "moderate," or "severe". Time to improvement was calculated from the time of treatment initiation to the time when all symptoms were assessed as "none" or "mild".

Oseltamivir phosphate can be used for the treatment of cough from viral infections, specifically influenza. The medication has been shown to reduce the median time to improvement in influenza-infected subjects.

• The treatment effect of oseltamivir phosphate was demonstrated in clinical trials, with a reduction in the median time to improvement of influenza-associated symptoms, including cough.
• Oseltamivir phosphate is administered orally, 75 mg twice daily for 5 days, for the treatment of influenza.
• The medication has been studied in various populations, including adults, adolescents, and pediatric subjects. 2

From the Research

Treatment of Cough from Viral Infections

• The treatment of cough from viral infections is a complex issue, and there is no single approach that can be applied to all cases 3.
• According to a study published in 2021, dextromethorphan (DM) has been shown to have anti-viral activity against influenza, and its use has been associated with reduced hospitalization rates in patients with laboratory-confirmed influenza 4.
• Other studies have also investigated the use of antiviral treatments for influenza, including neuraminidase inhibitors and cap-dependent endonuclease inhibitors, which have been shown to be effective in reducing the severity and duration of symptoms 5.
• In terms of chronic cough, a study published in 2017 identified four common causes: upper airway cough syndrome, gastroesophageal reflux disease/laryngopharyngeal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis, and recommended a step-wise approach to evaluation and management 6.
• For acute cough in children, evidence-based guidelines recommend a "wait, watch, review" approach, with education on expected illness duration, risks of over-the-counter medications, and safe, supportive care measures to alleviate discomfort 7.

Management of Cough

• The management of cough from viral infections requires a multifaceted approach, taking into account the underlying cause of the cough and the presence of any underlying conditions 3.
• Treatment options may include antiviral medications, such as oseltamivir or zanamivir, as well as supportive care measures, such as rest, hydration, and cough suppression 4, 5.
• In some cases, referral to a specialist, such as a pulmonologist or otolaryngologist, may be necessary to rule out underlying conditions or to manage refractory cough 6.

Special Considerations

• In children, acute cough is often a self-limiting condition, and treatment should focus on supportive care measures, rather than the use of over-the-counter cough and cold medications 7.
• In patients with underlying conditions, such as chronic obstructive pulmonary disease or asthma, treatment of cough from viral infections may require a more tailored approach, taking into account the patient's individual needs and medical history 6.