[Summary of NHG practice guideline 'Acute cough']

Coughing is usually caused by an uncomplicated respiratory tract infection for which antibiotics are not useful. Noscapine and codein are not advised. When the risk of complications is increased (because of age or relevant comorbidity), the decision to prescribe an antibiotic is based on the clinical presentation and any necessary additional investigations. Determination of the CRP value can assist in differentiating between pneumonia and a mild lower respiratory tract infection in moderately sick adults with several general and/or local symptoms. Patients with pneumonia should be prescribed antibiotics. Because of increasing resistance to doxycycline and macrolides, amoxicillin is the drug of first choice, and doxycycline of second choice. In the case of increased risk of severe pneumonia due to Coxiella burnetii (Q-fever) or Legionella, doxycycline remains first choice. In the case of whooping cough, additional investigation is advised if there are infants or third trimester pregnant women in the immediate environment. In moderately severe croup a single dose of glucocorticoids should be given; children with severe croup should be referred to a paediatrician.