The UK National Institute for Health and Care Excellence (NICE) published a guideline on antimicrobial prescribing for acute cough in February 2019. Only minor updates and clarifications have been made since.
The guideline helpfully reminds healthcare practitioners and patients that acute cough is a self-limiting condition most commonly caused by a viral infection of the upper respiratory tract and can also be caused by acute bronchitis in the lower respiratory tract, again most often a viral infection.
The NICE guideline recommends not to offer antibiotics for an acute cough unless patients are systemically very unwell or are at high risk of complications such as those with heart, lung, renal or liver disease or immunosuppressed.
Guidance on treatment emphasises the need to remind patients of the transient nature of acute cough and how to manage the condition with self-care treatments. The self-care treatments recommended with some evidence were:
1. Honey
2. Pelargonium
3. Over the counter cough medicine containing the expectorant guaifenesin
4. Over the counter cough medicine containing cough suppressants (except codeine)
In relation to pelargonium, in there was a summary of the committee discussion later in the guideline, the evidence having been derived from the systematic review of Wagner et al. (2015) and the Cochrane Review (Timmer et al., 2013). The committee agreed that there was some evidence that P. sidoides reduced cough symptoms for patients with acute bronchitis and that the available evidence suggested that liquid was more beneficial than tablets. They observed that there were an increased number of people with adverse events in the Pelargonium treatment compared to the placebo groups which were largely gastrointestinal in nature. The committee did not recommend Pelargonium for children under the age of 12 years.
In the tools and resources section of the guideline website there is a useful visual summary with a treatment algorithm and an endorsed resource from the Self Care Forum on cough in adults.
