Antibiotics should not be issued as first line of treatment for a cough

People should take honey or cough medicines instead but speak to their GP if it persists for longer than three weeks

Honey and over-the-counter remedies should be a patient’s first point of call to treat a cough, not antibiotics, says NICE and PHE in new draft guidance.

In most cases, acute coughs are caused by a cold or flu virus, or bronchitis, and last around three weeks.

Clinicians are advised in most cases not to offer antibiotics as they make little difference to a person’s symptoms. 

Dr Tessa Lewis, GP and chair of the NICE antimicrobial prescribing guideline group said: "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. 

“People can check their symptoms on NHS choices or NHS Direct Wales or ask their pharmacist for advice. 

“If the cough is getting worse rather than better or the person feels very unwell or breathless then they would need to contact their GP."

There are self-care products that people can take to manage their symptoms themselves. 

Honey and cough medicines containing pelargonium, guaifenesin or dextromethorphan have some evidence of benefit for the relief of cough symptoms.

The NICE draft guidance states it is important the reasons for not giving an antibiotic are clearly explained by the healthcare professional and advice is given to the patient on appropriate self-care.

Dr Susan Hopkins, healthcare-associated infection and antimicrobial resistance deputy director at Public Health England, said: “Antibiotic resistance is a huge problem and we need to take action now to reduce antibiotic use. Taking antibiotics when you don’t need them puts you and your family at risk of developing infections which in turn cannot be easily treated. 

“These new guidelines will support GPs to reduce antibiotic prescriptions and we encourage patients to take their GPs advice about self-care.”

An antibiotic may be necessary for acute cough when a person has been identified as being systematically unwell or if they are at risk of further complications for example, people with a pre-existing condition such as lung disease, immunosuppression or cystic fibrosis. 

Clear information about the most appropriate choice of antibiotic and duration of the course are outlined in the new guideline. 

Professor Mark Baker, director of the centre for guidelines at NICE said: “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.

“When prescribing antibiotics, it is essential to take into account the benefit to the patient and wider implications of antimicrobial resistance, only offering them to people who really need them.

“This guideline gives health professionals and patients the information they need to make good choices about the use of antibiotics. We encourage their use only when a person is at risk of further complications.”

This draft guideline is part of a suite of antimicrobial prescribing guidance developed with Public Health England to help manage common infections and prevent antimicrobial resistance. Information about managing sinusitis, sore throat and otitis media can be found on our website.