Treatment of Cough and Upper Respiratory Infection

Initial Assessment and Classification

The European Respiratory Society recommends determining if the cough is acute (<3 weeks), subacute (3-8 weeks), or chronic (>8 weeks) to guide treatment approach 2
The European Respiratory Society suggests ruling out pneumonia and other serious conditions requiring specific treatment 1
Consider underlying causes such as postinfectious inflammation, upper airway cough syndrome, or asthma, as recommended by the European Respiratory Society 2

The European Respiratory Society recommends Dextromethorphan for patients with a dry and bothersome cough, particularly when it disrupts sleep 1, 3
Codeine may be considered for short-term symptomatic relief in patients with chronic bronchitis but has limited efficacy for URI-related cough, according to the American College of Chest Physicians 3, 4
The American College of Chest Physicians recommends Inhaled ipratropium bromide as the only recommended inhaled anticholinergic agent for cough suppression in URI or bronchitis 4, 2

The European Respiratory Society advises against prescribing Expectorants, mucolytics, and antihistamines in acute LRTI in primary care as consistent evidence for beneficial effects is lacking 1, 4
The American College of Chest Physicians states that Antibiotics have no role in treating uncomplicated URI or postinfectious cough as most cases are viral in origin 5, 2

The European Respiratory Society recommends considering antibiotic treatment only in patients with suspected or definite pneumonia, age >75 years with fever, cardiac failure, insulin-dependent diabetes mellitus, or serious neurological disorders 1
The American College of Chest Physicians suggests considering antibiotic treatment for suspected pertussis infection (paroxysmal cough with post-tussive vomiting or inspiratory whooping sound) 5, 2

The American College of Chest Physicians advises against prescribing antibiotics for viral infections, which provides no benefit and contributes to antibiotic resistance 5, 1
The European Respiratory Society warns against using cough suppressants when the cough is productive and helping to clear mucus 1
The American College of Chest Physicians recommends recognizing when cough persists beyond expected timeframes, which may indicate a more serious condition 5, 6