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Acute Cough

Treatment of acute cough should target the underlying etiology of the illness, the cough reflex itself, and any additional factors that exacerbate the cough. When influenza isdiagnosed, treatment with amantadine, rimantadine, oseltamivir, or zanamivir is equally effective (1 less day of illness) when initiated within 30–48 hours of illness onset. In the setting of Chlamydia orMycoplasma-documented infection or outbreaks, first-line antibiotics include erythromycin, 250 mg orally four times daily for 7 days, or doxycycline, 100 mg orally twice daily for 7 days. In patientsdiagnosed with acute bronchitis, inhaled 2-agonist therapy reduces severity and duration of cough in some patients. Evidence supports a modest benefit of dextromethorphan, but not codeine, on coughseverity in adults with cough due to acute respiratory tract infections. Treatment of postnasal drip (with antihistamines, decongestants, or nasal corticosteroids) or GERD (with H2-blockers or proton-pumpinhibitors), when accompanying acute cough illness, can also be helpful. There is good evidence that vitamin C and echinacea are not effective in reducing the severity of acute cough illness after itdevelops; however, evidence does support vitamin C (at least 1 g daily) for prevention of colds among persons with major physical stressors (eg, post-marathon) or malnutrition.

Persistent andChronic Cough

Evaluation and management of persistent cough often requires multiple visits and therapeutic trials, which frequently lead to frustration, anger, and anxiety. When pertussis infection issuspected or confirmed, treatment with macrolide antibiotics is appropriate to reduce shedding and transmission of the organism. When pertussis infection has lasted more than 7–10 days, antibiotictreatment does not affect the duration of cough, which can last up to 6 months. There is no evidence to guide how long treatment for persistent cough due to postnasal drip, asthma, or GERD should be...