New guidelines released! Please use this medicine for children's cough!

Mom: Medicine baby, my baby starts coughing again when the weather gets cold. What medicine can stop the cough quickly?

Mom: My baby has a terrible cough, can using a few different medicines help him get better sooner?

Don't use random medicines for your baby's cough. You must use targeted medicines based on the cause and condition of the disease. Don't use a blanket approach!

Recently, the "Chinese Clinical Practice Guidelines for Diagnosis and Treatment of Children's Cough (2021 Edition)" jointly formulated by the Clinical Pharmacology Group of the Pediatrics Branch of the Chinese Medical Association, the National Clinical Medical Research Center for Child Health and Disease, and the Respiratory Group of the Pediatrics Branch of the Chinese Medical Association was released, answering important clinical issues in the diagnosis, treatment, and health education of children's cough. You can find answers to all the questions of mothers here!

Understand this knowledge

First, let’s understand the relevant terms for children’s cough:

Cough course: According to the duration of children's cough, it can be divided into acute cough (4 weeks).

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Classification of cough nature: Coughs are divided into dry coughs and wet coughs depending on whether there is sputum or not.

Specific chronic cough: refers to a chronic cough that can be attributed to an underlying disease (usually of pulmonary origin). Through examination and evaluation, the underlying cause of most chronic coughs can be identified.

Nonspecific chronic cough refers to a chronic cough with cough as the main or only symptom, which still has no clear cause after appropriate examination and evaluation.

There are answers to these questions

Question: Some people say that coughs can be cured quickly with antibiotics. Can babies use them?

Answer: It is not recommended to routinely use antibiotics to treat children with acute cough.

Because there are many causes of cough, oral amoxicillin or amoxicillin-clavulanate potassium is recommended as the first choice only when it is clinically determined that children with acute cough need to use antibiotics. The routine course of treatment is 5 to 7 days.

It is recommended to use antibiotics empirically to treat children with chronic wet cough. The first choice is oral amoxicillin-clavulanate potassium (7:1-14:1) 25-30 mg/(kg/time) (calculated according to the amoxicillin dose), once every 12 hours, for at least 2 weeks (the maximum dose of amoxicillin should not exceed 2 g/day).

Acute cough in children is usually caused by viral infection and is self-limiting. Early use of antibiotics does not relieve cough and other symptoms or shorten the course of the disease. Instead, it can cause adverse drug reactions and induce bacterial resistance, so it is not routinely recommended. When the course of acute cough is prolonged or symptoms worsen, especially in children with underlying diseases, the possibility of bacterial infection should be considered and antibiotics should be used empirically.

Question: Should I use expectorant and cough suppressant medicine for acute cough?

A: If the baby has an acute cough, it is not recommended to routinely use expectorants and antitussives. Children under 2 years old should be treated with caution.

At present, there is insufficient evidence on the effectiveness of antitussive drugs in treating children's cough, and they may cause a variety of adverse reactions. There is also a lack of research reports on the effectiveness and safety of expectorants in treating acute cough in children. The European Medicines Agency does not recommend the use of expectorants in children under 2 years old. Expectorants have indications: they can only be used when there is a wet cough, sputum obstruction, or when it affects the child's life and study.

Q: Medication is not recommended for acute cough, but what if the acute cough turns into a chronic cough without medication?

Answer: In more than 50% of children, cough caused by acute respiratory infection will naturally last more than 10 days. Therefore, necessary observation and waiting are very important!

The common causes of chronic cough in children in my country are cough variant asthma, upper airway cough syndrome and post-infectious cough. Chronic cough requires finding the cause and then targeted and standardized treatment. When parents find that their children have cough symptoms, they must not blindly stop the cough, but should go to the pediatric department as soon as possible.

Author: Luo Yuxuan and Chen Xing, Chief Pharmacist of Eastern Theater Command General Hospital

Review experts: Lan Xiaohong and Gao Ming, deputy director and pharmacist of the Eastern Theater General Hospital