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NICE promotes honey and OTC mixtures for most coughs

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Honey or over-the-counter cough medicines should be the first port of call for people with a nasty cough, according to new draft guidance, which advises clinicians not to prescribe antibiotics.

The vast majority of acute coughs are caused by the cold or flu virus – or bronchitis – and antibiotics make little difference to symptoms, stated the draft antimicrobial prescribing guidance.

“We would expect the cough to settle over 2-3 weeks and antibiotics are not needed”

Tessa Lewis

Most people get better within three weeks without medication, stressed the document published today by the National Institute for Health and Care Excellence.

Instead, patients can be advised to seek relief by taking “self-care” products such as honey or cough mixtures containing pelargonium, guaifenesin or dextromethorphan, which have been found to be of some benefit.

The draft guideline from NICE is one of a series developed with Public Health England in a bid to tackle the over-prescribing of antibiotics.

It makes it clear that clinicians should only consider prescribing antibiotics for acute cough – defined as a cough lasting up to three weeks – in certain circumstances.

“If someone has a runny nose, sore throat and cough we would expect the cough to settle over 2-3 weeks and antibiotics are not needed,” said Dr Tessa Lewis, a GP and chair of the antimicrobial prescribing guideline group.

“We want people to be offered advice on alternatives that may help ease their symptoms”

Mark Baker

The guidance suggests an antibiotic may be necessary when a patient is “systemically very unwell” or at risk of further complications, such as those with an existing condition like lung disease, immunosuppression or cystic fibrosis.

The draft NICE guideline includes information about the most appropriate choice of antibiotic and the length of treatment.

In addition, it highlights that the reasons for not giving an antibiotic should be clearly explained by healthcare professionals who should then offer patients advice on self-care.

The committee of experts that drew up the document reviewed a range of potential remedies and identified a limited number of substances – including honey – with some evidence to show they can help alleviate acute cough symptoms.

They found there was not enough evidence to recommend the use of herbal medicines including echinacea, or ivy, primrose and thyme – available on their own or mixed together.



However, there was some evidence to suggest extract of pelargonium sidoides – a type of geranium – was of some benefit and “people may wish to try it”.

Cough medicine containing the expectorant guaifenesin may help older children and adults, while products containing the cough suppressant dextromethorphan were worth a go for those aged 12 and over.

Other treatments such taking ibuprofen, codeine and over-the-counter antihistamines and decongestants have not been shown to be effective in tackling acute cough, the committee concluded.

Professor Mark Baker, director of the centre for guidelines at NICE, said it was vital to ensure antibiotics were only offered to patients that really needed them.

“We are keen to highlight that in most cases, antibiotics will not be necessary to treat a cough. We want people to be offered advice on alternatives that may help ease their symptoms,” he said.

“This guideline gives health professionals and patients the information they need to make good choices about the use of antibiotics,” he added.

The consultation on the draft guideline closes on 20 September.

Donna Castle, director of public affairs at the Proprietary Association of Great Britain, welcomed the draft guidance.

“It is encouraging that NICE draft guidance recommends that unless they have a pre-existing lung condition, adults with an acute cough should be advised to self care and use OTC cough products, rather than seeking a GP’s prescription,” she said.

“If used in accordance with the instructions on the packaging and in the patient information leaflet, then cough medicines are an appropriately safe way to help relieve the disruptive symptoms of a cough so people can get on with their day,” said Ms Castle.

She added: “PAGB believes it is important to empower people to self care for self-treatable conditions, like coughs, to help to reduce unnecessary pressure on overstretched NHS services, ensuring people are seen by the right healthcare professional at the right time.”

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