What is the first line treatment for cough?

From the Guidelines

For a first-line treatment of cough, I recommend starting with dextromethorphan (15-30mg every 4-6 hours) for non-productive coughs or guaifenesin (200-400mg every 4 hours) for productive coughs with mucus, as suggested by the most recent and highest quality study 1. These over-the-counter medications are effective for most uncomplicated coughs. Pair medication with adequate hydration (at least 8 glasses of water daily) and honey (1-2 teaspoons, especially before bedtime) which has natural cough-suppressing properties. Using a humidifier at night can also help by moistening airways. If the cough is due to postnasal drip, consider adding an antihistamine like loratadine (10mg daily). These treatments work by either suppressing the cough reflex in the brain (dextromethorphan), thinning mucus to make it easier to clear (guaifenesin), or reducing irritation in the throat (honey and hydration). If the cough persists beyond 2 weeks, worsens significantly, or is accompanied by high fever, chest pain, or difficulty breathing, medical evaluation is necessary as this could indicate a more serious condition requiring prescription medication or different treatment, as noted in 1 and 1.

Some key points to consider when managing cough include:

• Determining whether the cough is caused by a potentially serious illness or a non-life threatening condition, as emphasized in 1
• Considering a diagnosis of postinfectious cough if the cough has been present for at least 3 weeks but not more than 8 weeks, as suggested in 1
• Using inhaled corticosteroids as first-line treatment for chronic cough due to asthma or non-asthmatic eosinophilic bronchitis, as recommended in 1
• Stepping up the inhaled corticosteroid dose and considering a therapeutic trial of a leukotriene inhibitor if response to initial treatment is incomplete, as suggested in 1

From the FDA Drug Label

Purpose Cough suppressant Package/Label Principal Display Panel Compare to Delsym® active ingredient Dextromethorphan Polistirex Extended-Release Oral Suspension Cough Suppressant Dextromethorphan (PO) is used as a cough suppressant.

• It is used for cough relief 2 2

From the Research

First Line Treatment for Cough

• The first line treatment for cough depends on the duration and cause of the cough 3, 4, 5.
• For acute cough (less than 3 weeks duration), the most common cause is a viral upper respiratory tract infection (URI) or common cold, and treatment is typically focused on symptom management 3, 5.
• The most effective treatment for cough due to the common cold is a combination of a first-generation antihistamine plus decongestant 5.
• For chronic cough (more than 8 weeks duration), the goal is to evaluate and treat all potential underlying etiologies, and treatment may involve pharmacological and non-pharmacological therapies 3, 4.

Treatment of Upper Respiratory Tract Infections

• Upper respiratory tract infections (URTIs) are typically viral and account for billions of dollars in annual health care costs 6.
• Recommended therapy for the common cold involves symptom management with over-the-counter drugs, though the Food and Drug Administration advises against use of these drugs in children younger than 6 years 6.
• Early intervention with mucoadhesive gel nasal sprays has shown promising results for the prevention and treatment of acute URTI 7.

Antibiotic Use

• Antibiotics are not indicated for most cases of acute cough, and are only recommended for bacterial infections such as streptococcal pharyngitis or acute otitis media in certain high-risk patients 5, 6.
• Antibiotics should only be prescribed if test or culture results are positive, or if symptoms worsen or do not improve after an additional 7 days 6.