From the Guidelines
If you're still experiencing a horrible cough two weeks after completing antibiotics, you should contact your healthcare provider for further evaluation, as this could indicate post-infectious cough, which may last 3-8 weeks 1. When a patient complains of cough that has been present following symptoms of an acute respiratory infection for at least 3 weeks, but not more than 8 weeks, consider a diagnosis of postinfectious cough, as stated in the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1. Some key points to consider in the management of postinfectious cough include:
- Therapy with antibiotics has no role, as the cause is not bacterial infection 1
- Consider a trial of inhaled ipratropium as it may attenuate the cough 1
- In patients with postinfectious cough, when the cough adversely affects the patient’s quality of life and when cough persists despite use of inhaled ipratropium, consider the use of inhaled corticosteroids 1
- For severe paroxysms of postinfectious cough, consider prescribing 30 to 40 mg of prednisone per day for a short, finite period of time when other common causes of cough have been ruled out 1 In the meantime, you can try over-the-counter cough suppressants containing dextromethorphan, or guaifenesin to help thin mucus, stay well-hydrated, use a humidifier at night, and consider honey and lemon tea for soothing relief, while avoiding irritants like smoke or strong fragrances 1. If you develop new symptoms like fever, chest pain, shortness of breath, or are coughing up blood, seek immediate medical attention as these could indicate a more serious condition requiring prompt treatment.
From the Research
Cough Persistence After Antibiotics
- A horrible cough 2 weeks after completing antibiotics can be caused by various factors, including the underlying condition that was being treated, potential side effects of the antibiotics, or a new infection 2.
- It is essential to note that antibiotics are only effective against bacterial infections, and their use against viral infections can lead to unnecessary side effects and contribute to antibiotic resistance 3, 4.
Potential Causes of Persistent Cough
- Upper airway cough syndrome, gastroesophageal reflux disease/laryngopharyngeal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis are common causes of chronic cough in adults 2.
- In children, cough is considered chronic if present for more than four weeks, and the most common causes include asthma, protracted bacterial bronchitis, and upper airway cough syndrome 2.
Treatment Options
- The choice of antibiotic and treatment duration can significantly impact the resolution of symptoms, as seen in studies comparing azithromycin and amoxicillin/clavulanate for acute sinusitis and bronchiectasis 5, 6.
- Amoxicillin-clavulanate has been shown to be effective in achieving symptom resolution in non-severe respiratory exacerbations in children with bronchiectasis, with a relative risk of 1.50 compared to placebo 6.