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Avoid antibiotics, cold medicines for coughing youngsters

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Short-term coughs in children are often caused by a viral infection and parents should avoid heading to the pharmacy for cough medicine or to the doctor for antibiotics, a new journal article recommends.

The article, by Dr Danielle Wurzel, Dr Julie Marchant and Professor Anne Chang from the Royal Children’s Hospital in Brisbane is published in the latest edition of Australian Prescriber.

The authors said that cough was the most common symptom presented to GPs and pharmacists in Australia, with a study finding that one in three respiratory episodes were associated with a doctor’s visit and one in four required time off school or work.

Dr Wurzel said that it was not always possible for a doctor to determine the precise reason for a cough in children.

“What we do know is that upper respiratory infections are very common in young children, and it is normal for them to have several uncomplicated infections every year,” she said.

“In these cases, over-the-counter cough and cold medicines are not recommended because there is a lack of evidence that they will work, as well as the possibility that they might pose a safety risk, which is why the Therapeutic Goods Administration (TGA) now recommends that they should not be used in children under six years, and only used in children aged six to 11 years on advice from a doctor.”

Dr Wurzel said pain relief medicines like paracetamol or ibuprofen might help with other symptoms, and taking honey (in children older than one year) or using menthol-based rubs might help with night time coughing.

“Importantly, antibiotics should be avoided for children who have a cough associated with a mild upper respiratory tract infection, because the cough is more than likely viral in origin.”

The study’s authors said that a cough related to an upper respiratory tract infection might last between five and seven days or even up to three weeks, and that avoiding passive smoke exposure could help.

“Of course, there are certain situations where people should certainly seek urgent medical attention, including if the child has rapid breathing, if there is a suspected inhaled foreign body, if the child is very breathless, is vomiting, can’t eat, has persistent fever or is very lethargic,” the authors said.

Coughs which do not resolve, require further investigation.

The article said appropriate management of childhood coughs depended on accurate assessment. It advised doctors that a patient history should include: cough duration; characteristics of cough; questions about choking episodes and previous respiratory illness; associated wheeze; other symptoms such as weight loss, appetite or rash; and an immunisation history.

For more serious or prolonged episodes of childhood cough, a number of specific diseases should be considered. These include croup, pneumonia, bronchiolitis and whooping cough.

Debra Vermeer