Duration Health

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, 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.

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, is highly recommended to try guaifenesin or a cough suppressant first and wait to see if your symptoms resolve, especially if you do not have a fever.

When To Worry

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

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)

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-125mg 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

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.

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

InfectionDisposable

Oseltamivir (generic for Tamiflu) treats influenza.

InfectionMedication

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.

InfectionMedication

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.

InfectionMedication

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

GeneralMedication

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.

GeneralMedication

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

GeneralMedication

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

GeneralMedication

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