“You seem to be hving a lot of cough, said the doctor, Natuarally, the patient retorteds. I have been practicing right throughout the night”
Treatment
Ordinary dry cough with throat pain arising from pharyngitis, laryngitis and bronchitis is one of the commonest symptoms seen in General Practice.
Instructions:
1. Steam Inhalations 2-3 times/ day. Add to water Tinc. Benzoine, Vicks or Amrutanjan. 2. Warm salt water gargles. 3. Take hot drinks like hot tea, coffee, milk or soups 5-6 times/ day. 4. If cough is severe, advise rest at home and voice rest if laryngitis. 5. If smoker, advise to stop smoking. 6. Instruct to cover the mouth while coughing (Using hand or handkerchief) to prevent spread of infection to other family members.
Drug Treatment: 1. Cap. TERRAMYCIN 500mg tds x 5. 2. Supressa 1-2 tsp tds (Dextromethorphan) or Linctus Codedine 1 tsp tds. 3. If associated with fever, Add: Tab. CROCIN 1tds and if fever 4. If associated with common colds, Add anti histaminic Tab. Rinostat ½ - 1 tds (Anti cold combination) 5. If associated with Body ache, Add NSAID: Tab. Disprin 1 tds or Tab. Combiflam. 6. If associated with occasional rhonchii Add broncholidator: Tab. ASTHALIN 4mg x tds. Tab. Wysolon 5mg tds x 3. 7. If associated with expectoration Give: Tab. AVIL expectorant tsp tds Tab. Bromhexeine 8mg. tds.
There major points in deciding treatment of cough are its duration presence of expectoration and presence of wheezing.
The choice of antibiotic will vary from doctor to doctor and from locality to locality.
In general for mild infections use milder antibiotics like Tetracyclins, Septran, Erythromycin, Ampicilin-Amoxycilin, Gentamycin.
In infection is sever start with penicillin, Roxithromycin, Cefalosporins or Pefloxacin.
In infection is not controlled in 3 days. 1. Cap. NUFEX 500mg. qid (Cephlexin) Change to Higher Antibiotic or Inj. Pencilin 10lacs IM x A.T.D x OD 6 (pencilin is one of the most effective drugs in respiratory tract infections) 2. Tab. Wysolene 5mg. tds x 5 (Prednisolone) 3. Auscultate carefully for wheezing and rhonchil. 4. If no response, ask for investigations, Hb%, WBC for eosinophilia. X-ray chest for TB, pneumonia etc. If other investifations are normal, HIV test. 5. If Eosinophills, i.e Tropical Eosionophillia. T. HETRAZAN 1 tds x 21 days (Diethyl Carbamazine Citrate) Tab. Wysolene 1 bd x 10-15 days
Indications for X-ray
Cough > 15days Chest pain on breathing, high fever or dysnopea. Rales, cavity or abnormal breath sounds. Loss of weight or gross emaciation. Hemoptysis. No response to antibiotics for 1 week.
Ensuring good hydration with adequate oral fluids, steam inhalations if required. Avoidance of chilled drinks, dust and fume exposure. Avoiding prolonged use of antihistamines (that dry up the throat and aggravate cough) and ‘cough expectorants’ that perpetuate reflex cough. Measures to prevent gastro-eosophageal reflux, as detailed under GERD.
Advice to Patient
Warm patient of sedating effect of opiates and Antihistamines. Advice patient on the utility of simple measures outlined above.
Prevention
In established epidemics Influenza Vaccine to vulnerable groups like the aged and immuno-suppressd Avoidance smoking, Protection against occupational exposure, Preventive measures for Bronchial asthma. Withdrawal of causative drugs like ACE inhibitors, antihistamines.
