Duration Health — Field Guide: Cough

Cough

Introduction

There are many causes of cough, including viruses causing congestion in the upper part of the respiratory tract, viruses or bacteria causing an infection of the air sacs in the lungs (pneumonia), or breathing a foreign body into the lungs (aspiration). If you believe you may have aspirated a foreign body, seek medical care immediately. In many cases, a cough is caused by a benign virus and will resolve on its own, however if the cough is prolonged and/or associated with high fever, it might be due to a bacterial infection that could need antibiotic treatment. If you have a cough that persists longer than one week without improving, cough with shortness of breath, if you are coughing up blood, or if you have a cough with weight loss, these could be signs of a serious medical problem, and you should seek help immediately.

Treatment

Treatment of cough depends on the cause of the cough. If a cough is due to congestion from a viral infection, you may try an expectorant like guaifenesin (generic for Mucinex®), or a cough suppressant. Bacterial infections, including pneumonia, may be treated with antibiotics like azithromycin, amoxicillin, or doxycycline.

If you have had exposure to someone with the flu (influenza A or B), you may benefit from taking the antiviral oseltamivir (generic for Tamiflu®). Oseltamivir has only been shown to help fight the flu if you start taking it within 48 hours of developing symptoms. It has not been shown to prevent serious complications of the flu like pneumonia or hospitalization. It will not help treat viruses other than the flu.

Most coughs do NOT need antibiotics. Millions of people suffer side effects every year, including uncontrollable diarrhea, after taking antibiotics for cough when one is not necessary. Before considering antibiotics, it is highly recommended to try guaifenesin or a cough suppressant first and wait at least 7-10 days to see if your symptoms resolve, especially if you do not have a fever, or if symptoms have been present less than one week.

When To Worry

Seek immediate medical care if you have any of the following:

  • difficulty breathing associated with your cough
  • chest pain associated with your cough
  • high fever and continued cough after taking antibiotics
  • cough that lasts longer than one week without improving
  • cough with possible aspiration of a foreign body

Pediatrics

Quick Guide

If you have

  • cough
  • sore throat
  • nasal congestion
  • muscle aches
  • NO fever

You may have

viral upper respiratory infection

Consider using

guaifenesin (generic for Mucinex®) 200 to 400 mg by mouth every 4 hours as needed, not to exceed 2400 mg per day

OR

ibuprofen 600 mg every 6 hours as needed for pain

OR

acetaminophen 1000 mg every 6-8 hours as needed for pain (do not exceed 3000 mg per day)

OR

Pediatrics

For children age 17 and under

guaifenesin 5 mL every 6 hours as needed

ibuprofen 10 mg/kg every 6 hours as needed; maximum 400 mg per dose

acetaminophen 15 mg/kg every 6 hours as needed; maximum 500 mg per dose

See also: Pediatrics

If you have

  • coughing up mucus or sputum
  • persistent cough
  • fever 100.4°F or higher
  • fatigue/malaise

You may have

pneumonia

Consider using

azithromycin 500 mg by mouth the first day, then 250 mg per day for the next 4 days

OR

doxycycline 100 mg by mouth twice daily for 5 days

OR

amoxicillin-clavulanate 875 mg-125 mg by mouth twice daily for 7 days

Note: if amoxicillin alone is available, consider using amoxicillin alone instead of amoxicillin-clavulanate combination

OR

levofloxacin 750 mg by mouth daily for 5 days

and seek emergency medical care

OR

Pediatrics

For children age 17 and under

amoxicillin 20 mg/kg/dose twice a day; maximum 1000 mg per dose for 10 days for pneumonia

azithromycin 10 mg/kg day 1, then 5 mg/kg daily for 4 days; max 500 mg on day 1 and 250 mg on subsequent days for atypical pneumonia in teens only

doxycycline and levofloxacin should not be used in children unless directed by a physician

See also: Pediatrics

If you have

  • body or muscle aches
  • nasal congestion, headache, cough
  • fever
  • fatigue/malaise
  • exposure to someone with the flu

You may have

influenza

Consider using

oseltamivir (generic for Tamiflu®) 75 mg twice daily for 5 days. Should start within 48 hours of symptom onset.

OR

Pediatrics

For children age 17 and under

oseltamivir only for use after positive flu test

See also: Pediatrics

If you have

  • persistent cough longer than one week
  • chest pain
  • shortness of breath
  • coughing up blood
  • weight loss
  • oxygen level <94% (see: pulse oximeter)

You may have

severe pneumonia, tuberculosis, cancer, blood clot in the lung (pulmonary embolism), severe COVID-19 or other life-threatening illness

You should

seek emergency medical care

Reference

N95 mask

N95 masks are used to prevent transmission of airborne illnesses. N95 masks are the tool of choice to prevent the spread of influenza.

InfectionDisposable

oseltamivir

Oseltamivir (generic for Tamiflu) treats influenza, the virus that causes the flu. Oseltamivir should be started within 48 hours of influenza symptoms. In some cases, people who do not have flu symptoms are given oseltamivir to help stop them from getting the flu because they are exposed to or come into close contact with someone who has the flu.

Prescription only

InfectionMedication

azithromycin

Azithromycin is an antibiotic. Azithromycin can be used to treat respiratory infections like pneumonia, abdominal infections, ear infections, throat infections, and other infections. It is often used in place of penicillin drugs in people with a penicillin allergy. It has a longer duration of action than other antibiotics, so it is usually given for a shorter course of therapy.

Prescription only

InfectionMedication

azithromycin pediatric

Azithromycin is an antibiotic. Azithromycin can be used to treat respiratory infections like pneumonia, abdominal infections, ear infections, throat infections, and other infections. It is often used in place of penicillin drugs in people with a penicillin allergy. It has a longer duration of action than other antibiotics, so it is usually given for a shorter course of therapy.

Prescription only

InfectionMedication

azithromycin suspension

Azithromycin is an antibiotic. Azithromycin can be used to treat respiratory infections like pneumonia, abdominal infections, ear infections, throat infections, and other infections. It is often used in place of penicillin drugs in people with a penicillin allergy. It has a longer duration of action than other antibiotics, so it is usually given for a shorter course of therapy.

Prescription only

InfectionMedication

levoFLOXacin

Levofloxacin (generic for Levaquin) is an antibiotic. It is used to treat pneumonia, urinary tract infections, prostatitis, anthrax, and bubonic plague. It is in the fluoroquinolone category of antibiotics.

Prescription only

InfectionMedication

guaiFENesin

Guaifenesin is an expectorant. It loosens mucous in the breathing passages, and is used to treat cough.

GeneralMedication

albuterol

Albuterol (generic for Ventolin) treats shortness of breath caused by bronchospasm, a sudden tightening of the muscles in the walls of the breathing passages (bronchioles). Bronchospasm can be caused by asthma, exercise, chronic bronchitis, and anaphylaxis. Albuterol inhalers deliver this medication directly to the breathing passages. Common adverse effects of treatment with inhaled albuterol include palpitations, chest pain, rapid heart rate, tremor, and nervousness. Prime the albuterol inhaler before using it for the first time, when the inhaler has not been used for more than 2 weeks, or when the inhaler has been dropped. To prime the inhaler, release 4 sprays into the air away from the face, shaking well before each spray.

Prescription only

GeneralMedication

ibuprofen

Ibuprofen (generic for Motrin, generic for Advil) is a pain reliever and the most commonly used non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to treat pain.

GeneralMedication

acetaminophen

Acetaminophen (generic for Tylenol) is a pain reliever and fever reducer. Acetaminophen is used to treat pain.

GeneralMedication

ibuprofen blisterpack

Ibuprofen (generic for Motrin, generic for Advil) is a pain reliever and the most commonly used non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to treat pain.

GeneralMedication

acetaminophen blisterpack

Acetaminophen (generic for Tylenol) is a pain reliever and fever reducer. Acetaminophen is used to treat pain.

GeneralMedication

acetaminophen pack

Acetaminophen (generic for Tylenol) is a pain reliever and fever reducer. Acetaminophen is used to treat pain.

GeneralMedication

ibuprofen pack

Ibuprofen (generic for Motrin, generic for Advil) is a pain reliever and the most commonly used non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to treat pain.

GeneralMedication

cefdinir

Cefdinir is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

cefdinir suspension

Cefdinir is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

cefpodoxime

Cefpodoxime is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

cefuroxime

Cefuroxime is a broad-spectrum antibiotic that treats many types of infections including urinary tract infections, respiratory infections, and ear/nose/throat infections. It is also sometimes used to treat the STD gonorrhea. It is in the cephalosporin family of antibiotics.

Prescription only

InfectionMedication

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