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Recommend honey and herbal remedies as first-line for acute cough, says NICE

Practice nurses should recommend honey, herbal remedies and cough medicines as first-line treatment for acute cough, according to new draft NICE guidance.

The guideline, which covers prescribing for acute cough associated with an upper respiratory tract infection or acute bronchitis in adults, young people and children, has been developed with Public Health England as part of the agenda to halt antimicrobial resistance.

It recommends that antibiotics should not be prescribed as first-line treatment, instead suggesting that practice nurses should ‘give general advice to people’ about:

  • ‘The usual course of acute cough (lasts up to three or four weeks)’;
  • ‘How to manage their symptoms with self-care’; and
  • ‘When to seek medical help, for example if symptoms worsen rapidly or significantly, do not improve after three or four weeks, or the person becomes systemically very unwell.’

In the ‘self-care’ section of the guideline, NICE says honey can be recommended for people over one year of age, alongside herbal remedy pelargonium.

It also recommends cough medicines containing the expectorant guaifenesin for people over 12, and cough medicines containing the antitussive dextromethorphan for people over 12 where the cough is ‘not persistent’.

The guideline says the self-care recommendation options are based on ‘limited evidence’ that they have ‘some benefit for the relief of cough symptoms’.

It also lists a range of cough medicines that have been found ineffective based on current evidence.

NICE added that an antibiotic may be necessary for an acute cough when a person has been identified as being systematically unwell or if they are at risk of further complications. They said this could include people with a pre-existing condition such as lung disease, immunosuppression or cystic fibrosis.

The guideline also includes guidance on the most appropriate choice of antibiotic, and course duration, for these cases.

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.’