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GPs go forth

GPs should recommend honey and herbal medicines for coughs, suggests NICE

GPs 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 GPs do not prescribe antibiotics as first-line treatment, but instead '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 which 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.'

NICE added that it was important for GPs to 'clearly explain' their reasons for not prescribing an antibiotic to patients.

Professor Baker said: 'When prescribing antibiotics, it is essential to take into account the benefit to the patient and wider implications of antimicrobial resistance, only offering them to people who really need them.

'This guideline gives health professionals and patients the information they need to make good choices about the use of antibiotics. We encourage their use only when a person is at risk of further complications.'

Public Health England antimicrobial resistance deputy director Dr Susan Hopkins said: 'These new guidelines will support GPs to reduce antibiotic prescriptions and we encourage patients to take their GPs advice about self-care.'

NICE's draft guidance on acute cough self care


Be aware that limited evidence suggests that the following have some benefit for the relief of cough symptoms:

  • honey (in people over one year of age)
  • pelargonium (a herbal remedy)
  • cough medicines containing the expectorant guaifenesin (in people over 12 years of age)
  • cough medicines containing the antitussive dextromethorphan (in people over 12 years of age and if the cough is not persistent, such as in asthma, or accompanied by excessive secretions).

Be aware that:

  • limited evidence suggests that antihistamines, decongestants and cough medicines containing the antitussive codeine do not help cough symptoms
  • no evidence for cough medicines containing pholcodine or simple linctus was found.

Source: NICE


Readers' comments (14)

  • David Banner

    Numpties Invoking Crap Evidence

    Was the “limited evidence” the chairman’s granny who swore by hot toddies? Or a Holland & Barrett study? Should we dip dummies in whisky? (worked for me). Or pop a frog in the mouth?
    Still, at least it might stop those pesky GPs from prescribing antibiotics, so who cares how crackers the advice is, eh?

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  • And the first kid that ends up in hospital with pneumonia, 24hours after GP recommended honey...who’s going to help you then? Charlie Massey will be rubbing his hands in glee

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  • How many time do we here patient say the hospital dr said the GP should have given antibiotic when we had not.

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  • Cough lasts 4 weeks, surely this cannot come from the same august body who had Alex Ferrguson putting the fear of God into the populace, urging consultation if cough lasted 3 weeks, so that you might get a little more time with your nearest and dearest........

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  • The question is should GPs be seeing minor self limiting conditions of a couple of days duration? I don’t mind seeing the odd one but dealing with case after case of the worried well drives me insane.

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  • I think I'm going to start using leeches again....also a large Ostrich feather so I can tickle the demons out of them

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  • 'Hot toddies and aspirin' were the most effective treatment for flu and suchlike I have experienced (but the association put me off the Uisce Beatha for life). 'Honey & Lemon' comes a distinct second.

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  • And the moronic PHE campaign song see your GP of your cough lasts 3 weeks

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  • Took Early Retirement

    I can only presume that the person who put this piece of brilliance together must be a silly one of these:-

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  • Vinci Ho

    How much money do the taxpayers pay these guys?
    Patients actually so often told me they had already tried these as per pharmacists . Of course , it is a hit and miss . But a ‘new’ NICE guidance , WTF!

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  • GPs don’t have magic powers to diagnose a virus from a bacterium chest infection, it comes down to guess work most of the time, as such the doctor WILL take the safest course of action which is to issue more antibiotics. Thanks but no thanks uk government

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  • If one were to chug enough dextromethorphan to ease a dry cough, the NMDA-receptor antagonist effect would propel you into a profound dissociative state similar to that induced by ketamine, or PCP. The cough might not be cured but who cares?

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  • The small print: "We will strike you off and charge you with gross negligence manslaughter if the condition changes and the patient dies taking the honey." What a waste of NICE resources.

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  • I hope I will be able to get the honey on prescription. Super strength Manuka, cheaper than the supermarket!

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