*For medical professionals only
What medicine to use? When to use? How to use it?
Cough is a protective reflex of the body and a common symptom of many diseases.
If the cause cannot be identified and treated in time, it may lead to a decline in the quality of life of the child, affect his normal physiological and psychological development, and even bring a series of complications of respiratory, cardiovascular, gastrointestinal and other systems.
If the drug is overused in the early stage, it may not only cause adverse drug reactions, but also may cover up the disease, delay diagnosis and treatment, and even lead to a prolonged course of the disease.
As the first caregiver of children, parents can understand the medical knowledge related to cough, early detection, rational medication, cooperation with treatment, and reasonable care, which plays an important role in the recovery of children with cough.
Cough in children is a common medication problem
Question 1: Do children with cough need to use antibacterial drugs? When to use? How to use it?
Children with acute cough (cough lasting < 2 weeks) do not require routine antimicrobials. Because acute cough is mostly caused by respiratory viral infections, antibacterial drugs have no therapeutic effect, and upper respiratory tract infections are self-limited diseases that can improve on their own without drugs.
Abuse of antibacterial drugs not only can not relieve cough, but may cause liver and kidney function damage, induce bacterial resistance, mask symptoms and lead to longer cough, so antibacterial drugs cannot be used routinely.
When the physician judges that children with acute cough need to use antibacterial drugs, oral amoxicillin or amoxicillin/clavulanate potassium can be used, generally taken for 5~7 days. When children are allergic to penicillin or drugs are not available, oral second-generation cephalosporins or macrolides may be considered.
When the child's acute cough is not good, or there is fever, purulent sputum, purulent discharge, and the level of inflammatory indicators is elevated in the blood routine of the blood examination, the doctor may determine that the child has a bacterial infection, and antibacterial drugs are needed at this time.
For children with chronic wet cough, oral amoxicillin/clavulanate potassium may be used for at least 2 weeks (the maximum dose of amoxicillin does not exceed 2 grams per day).
Question 2: Do children with acute cough need to use expectorants?
Children with acute cough do not require routine expectorants. Common pediatric expectorants include ambroxol, acetylcysteine, etc.
The efficacy of expectorants on cough is not certain, and in many cases there is no difference in the effect of placebo, so it is not necessary to actively use expectorants as soon as cough appears, especially in children with dry cough;
After the doctor's diagnosis, if the child has a lot of sputum, it is difficult to cough up, and it affects life and learning, it can be used as appropriate.
Question 3: Do children with cough need to use antihistamines?
Children with acute cough do not require routine use of antihistamines. If your child's cough is caused by allergic rhinitis, a second-generation antihistamine may be taken by mouth. If the child's cough is caused by another nasal disorder, a first-generation antihistamine plus decongestant may be used during the acute cough of children ≥ 6 years of age.
Antihistamines belong to the class of anti-allergic drugs. Commonly used first-generation antihistamines include diphenhydramine (click for complete medication information), chlorpheniramine, ketotifen, cyproheptadine, etc., which have a certain effect of reducing secretions and reducing cough, but they are also prone to drowsiness and fatigue; Commonly used second-generation antihistamines include cetirizine, loratadine, etc., which have higher safety but no cough effect.
The most common decongestant is ephedrine, which can quickly contract the nasal mucosal blood vessels and reduce the edema of the nasal mucosa, thereby reducing nasal congestion, but it should be noted that continuous medication should not exceed 7 days.
Question 4: In which cases can bronchodilators be used?
Children with acute cough do not require routine administration of bronchodilators. When doctors suspect that your child has cough-variant asthma (which measures nitric oxide levels in the airways), bronchodilators may be used to relieve symptoms and help diagnose based on their effectiveness.
Common bronchodilators include dextromethorphan, procaterol, terbutaline, etc. Bronchodilators improve cough symptoms in most children with cough-variant asthma.
If the child's cough is significantly relieved after bronchodilators, it may be suggestive of the diagnosis of cough-variant asthma.
Question 5: Do children with cough need to use antitussive medicine?
Children with cough do not require routine antitussics. Cough is a protective physiological reflex of the respiratory tract, to a certain extent is "beneficial", when the child coughs, parents and doctors need to actively look for the cause behind the cough, rather than blindly "cough".
Antitussives (e.g., dexmethadone) are used only as symptomatic treatment, not as the underlying treatment for cough, and may be associated with adverse effects. It can only be used if the cough is severe and affects the child's daily life, and it can be used as appropriate after evaluation by a doctor.
Question 6: Can inhaled corticosteroids be used for chronic nonspecific cough?
For some children with chronic non-specific cough (cough lasting more than 4 weeks and the cause cannot be identified) (such as allergies suggesting hormone-sensitive cough), inhaled corticosteroid therapy can be chosen, but after 2~4 weeks, the child needs to be re-evaluated by the doctor again and adjust the medication according to the efficacy.
Common inhaled corticosteroids include beclomethasone dipropionate, fluticasone propionate, budesonide, etc. Glucocorticoids have powerful anti-inflammatory and anti-allergic effects and are effective against common causes of chronic cough in children, such as cough variant asthma.
Inhaled corticosteroids act locally on the airways and have few systemic adverse effects, but they also need to be used under the guidance of a physician.
Question 7: Can leukotriene receptor antagonists be used for chronic non-specific cough?
Children with chronic nonspecific cough do not require routine leukotriene receptor antagonists.
Leukotriene receptor antagonists (such as montelukast sodium) can inhibit airway inflammation caused by leukotrienes (an inflammatory mediator), and can be used under the guidance of a physician for cough suspected to be associated with allergic rhinitis/asthma, and attention should be paid to the child's neuropsychiatric adverse effects such as hallucinations, insomnia, excitement, depression, etc.
Question 8: Do children with chronic cough need to use immunomodulators?
Children with chronic cough do not require routine immunomodulatory therapy.
Children with chronic cough due to recurrent respiratory infections may be treated with immunomodulators. Immunomodulators are drugs that regulate the body's immune function. Commonly used drugs are bacterial lysates and so on.
If the child frequently develops colds, bronchitis and pneumonia, immunomodulators can be used under the guidance of a physician to reduce the incidence of recurrent infections.
Question 9: Can antacids be used for chronic non-specific cough?
Question 10: How to treat psychogenic cough and habitual cough in children?
Question 11: What happens when the child coughs and needs to seek medical attention in time?
Are the above 3 questions clear to everyone? These conditions in children may indicate otitis media, sinusitis, bronchitis or pneumonia and need prompt treatment.
After thinking, you can long press and identify the QR code below to see if your answer is correct~
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, you can also go to the "Doctor Station Web Version" to get the answer~
Bibliography:
[1] ZHANG Cui, SONG Jun, XIN Yue, et al. Journal of Clinical Pediatrics,2014,32(7):668-671.)
[2] YU Gang,ZHANG Hailin,LI Changchong. Effects of chronic cough on the quality of life of children and their parents[J].Maternal and Child Health and Wellness,2011,23(4):52-53.)
[3] Clinical Pharmacology Group, Pediatrics Branch of Chinese Medical Association, National Clinical Research Center for Child Health and Disease, Respiratory Group of Pediatrics Branch of Chinese Medical Association, Pediatric Respiratory Professional Committee of Pediatrician Branch of Chinese Medical Doctor Association, Editorial Board of Chinese Journal of Pediatrics. Chinese clinical practice guidelines for the diagnosis and treatment of cough in children(2021 edition)[J].Chinese Journal of Pediatrics,2021,59(9):720-729.)
[4] Clinical Pharmacology Group, Pediatrics Branch of Chinese Medical Association, National Clinical Research Center for Children's Health and Disease (Children's Hospital Affiliated to Chongqing Medical University), Respiratory Group of Pediatrics Branch of Chinese Medical Association, Pediatric Respiratory Professional Committee of Pediatrician Branch of Chinese Medical Doctor Association, etc. Chinese Guide to Cough in Children South (2021 Patient Edition)[J].Journal of Pediatric Pharmacy,2021,27(Suppl):17-22.)
Responsible editor: Xiang Yu
*The "medical community" strives to publish content professionally and reliably, but does not make any commitment to the accuracy of the content; Relevant parties are requested to check separately when adopting or using it as a basis for decision-making.
