Post-Infectious Cough in Children

Diagnostic Approach

Post-infectious cough is a clinical diagnosis of exclusion that should be considered when cough persists for 3-8 weeks following an acute respiratory infection, according to the American Thoracic Society 1, 2
Children under 5 years have 3.8-5 respiratory infections per person per year, making post-infectious cough extremely common, especially in daycare settings, as reported by the American Academy of Pediatrics 3, 4
Common causative organisms include respiratory syncytial virus, influenza, parainfluenza, adenovirus, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Moraxella catarrhalis, and Bordetella pertussis, as identified by the Centers for Disease Control and Prevention 1, 3
Prolonged cough after Mycoplasma and Chlamydophila infections occurs in 28% and 57% of young children respectively, with cough lasting >21 days, according to the American College of Chest Physicians 1, 3

The cornerstone of treatment is reassurance and expectant management, as post-infectious cough resolves spontaneously in time, as recommended by the American Academy of Family Physicians 1, 2
Antibiotics have no role in treating post-infectious cough, as bacterial infection does not play a role in the pathogenesis, according to the Infectious Diseases Society of America 1, 2, 6
A trial of inhaled ipratropium bromide may attenuate the cough based on one small controlled trial in adults, as reported by the European Respiratory Society 1, 6
Consider inhaled corticosteroids (such as fluticasone propionate) when cough adversely affects quality of life and persists despite ipratropium, as recommended by the American College of Allergy, Asthma, and Immunology 1, 2, 6
For severe paroxysms of cough, consider a brief course of oral corticosteroids: prednisone 30-40 mg daily (or equivalent), tapering to zero over 2-3 weeks, as suggested by the American Thoracic Society 1, 2, 6

Suspect Bordetella pertussis when cough is accompanied by paroxysms, post-tussive vomiting, or inspiratory whooping sound, as recommended by the Centers for Disease Control and Prevention 7
Macrolide antibiotics are indicated when pertussis is confirmed or highly suspected, but only if started within the first 2 weeks of infection, according to the American Academy of Pediatrics 7
Early treatment diminishes coughing paroxysms and prevents disease transmission, requiring patient isolation for 5 days from treatment start, as reported by the World Health Organization 7

Do not use antibiotics empirically for post-infectious cough without confirmed bacterial sinusitis or pertussis, as recommended by the American College of Physicians 1, 5
Do not prescribe centrally acting antitussives (codeine, dextromethorphan) as first-line therapy; reserve these only when other measures fail, according to the American Academy of Family Physicians 6
Do not overlook back-to-back infections in winter months or coinfections, which can prolong coughing periods significantly, as reported by the American College of Chest Physicians 1, 3