Malcolm Thaler, MD

Do I Need Antibiotics for a Persistent Cough?

Acute Bronchitis Antibiotics

There are many reasons why a cough can persist for days and even weeks. Some coughs are caused by infectious diseases and some by noninfectious processes, such as gastroesophageal reflux (i.e., heartburn), asthma, or postnasal drip. However, acute bronchitis is by far the most common cause of a cough that lasts for several days and is unaccompanied by the classic symptoms of an old-fashioned cold, such as head and nasal congestion. So let’s say that you’ve had a cough for several days. Studies show that a majority of health care providers treat their patients who have just this symptom with antibiotics–and often broad-spectrum antibiotics. So surely it’s time for an antibiotic, isn’t it?

Antibiotics Not Helpful for Persistent Cough

In most cases, no. Recently, researchers reporting in the British journal The Lancet looked at over 2,000 patients of various ages with a cough lasting no more than 28 days, and randomized them to receive either placebo or a 7-day course of amoxicillin. Patients with suspected pneumonia or any of the noninfectious causes listed above were excluded from the study. The researchers found that amoxicillin did not shorten the duration of the cough, nor did it mitigate the severity of symptoms in persons of any age group, including the elderly.

Why? The answer is simple: Almost all cases of acute bronchitis are caused by a virus, and viruses don’t respond to antibiotics, most of which are antibacterial agents. So, in the vast majority of cases where a cough is the predominant symptom, an antibiotic won’t help.

When to See Your Health Care Provider

If you’re experiencing a persistent cough, when should you be concerned? There are several situations in which you should seek medical attention:

  • If you have any underlying illness compromising your health, such as heart disease or pulmonary disease.
  • If you feel really awful, are starting to produce a lot of thick phlegm and have a fever, especially if you become short of breath. See your primary care provider right away, as these symptoms may indicate pneumonia.
  • If you’ve been exposed to pertussis (i.e., whooping cough), an antibiotic may shorten its course if you take it within the first few days. It won’t help if you take it later than that, although it will lessen the likelihood of your spreading the illness.
  • If the cough just doesn’t go away–there may be something else that needs medical attention.

What’s the difference between bronchitis and pneumonia?

Bronchitis refers to inflammation of the large airways (aka bronchi) that channel air into your lungs. Bronchitis is caused exclusively by viruses. Pneumonia refers to inflammation of the lungs, involving the air sacs (aka alveoli) that transfer oxygen to your blood. It’s a more serious condition than bronchitis, with many possible causes, including bacterial and viral infections.

We don’t recommend antibiotics for uncomplicated acute bronchitis, which is typified by several days of persistent cough without symptoms suggestive of anything else. Your health care provider may advise you on over-the-counter or prescription medications that may help you feel better, but an antibiotic won’t help. And, as the study in The Lancet confirmed, an antibiotic may cause side effects such as diarrhea, nausea, rash, and severe allergic reactions.

So if you have a persistent cough, see your health care provider. He or she will probably be able to distinguish acute bronchitis from pneumonia simply by laying a stethoscope on your chest–but don’t insist on an antibiotic if you have acute bronchitis. It won’t help, and it might make matters worse.

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  1. Mary Ann Giles says:

    I have been coughing for 3 months, the cough is so bad, that I urinate on myself. The cough is so hard my throat feels like something is tearing. I have been to the doctor 6 times in the last 2 month. Right now I do not know what to do. I have been on so much medicine and none of them work. I am Diabetic and I can not keep food down what can I do?

    • Hi Mary Ann,

      Unfortunately we cannot provide specific medical advice online. We suggest continuing to work with your primary care provider to look into further for you. We hope you get better soon!

  2. Sarah says:

    I have had a cough for 3 weeks now. It started as a cold and I got the cough (which is normal for me as instead of getting a drippy nose it just runs down the back of my throat and makes me cough) anyway then i started having problems breathing, especially in aircon. Excercise helped both my coughing and breathing…while excercising i felt normal. as soon as i stopped i would start coughing again. I would have massive coughing fits every now and again which caused me to throw up, wet myself, have water streaming out of my eyes, my nose run and my face go extremely red. Then id calm down and just go back to normal coughing..luckily after the first 2 weeks my throat cough went away and so did these fits but i am still coughing and having problems breathing. I believe i may have acute bronchitis as i think my body is trying to cough up the flem in my lungs. It is now at the 3 week mark and my upper back hurts. I hope thats just from coughing and not a lung issue? I hope this goes away soon though….this is the worst coughing sickness thing ive ever had :(

    • Denise says:

      I don’t want to alarm you, but those were symptoms that I had before I learned I had heart disease. Everytime I caught a cold or flu, I would get better but the cough would remain for months. I would take cough medicine but that would make it worse and when I read the label it says don’t take if you have bronchitis, heart disease, etc. I self diagnosed myself as having bronchitis and just dealt with the cough until it went away on it’s own. I came to this page searching for some remedies for a cough, for someone like myself who has heart disease and can’t take most medicines, and came upon your question. I sincerely hope it’s not that, but please do have your heart checked and don’t let the doctors tell you different like they did to me for years, until I actually had to have open heart surgery. All the best to you.

  3. Jay Flores says:

    I went to my sister’s place and that time she had a cough until then after 3 days I got a cough too. My sister didn’t get a fever that time but me it got worst, after cough, I had runny nose, then I got a fever. It’s been a week since I checked myself out from the doctor. she just checked my mouth and check my back with stethoscope Then She gave me like an antibiotic, guaifenesin expectorant and for fever. I no longer have fever but I still have runny nose and cough. I had cough from time to time and every now and then. I already finished two bottles of syrup but nothing changes i just realized it got worst. My friend told me to try Salbutamol Carbocisteine as she said an effective syrup. I gave it a shot just earlier, I stopped taking antibiotics. For now I just take the Salbutamol Carbocisteine and for my runny nose the Neozep. Last night I was not able to sleep well also because of my cough. I think my cough is already 3 weeks. What would I do? Do I need to worry so much??

    • Thanks for your question Jay. It sounds like you need to have a follow up with your primary care doctor. We can’t provide personal medical advice online so your doctor should be able to take a closer look at the issue that you’re having with your cough.

  4. Martinique Cole says:

    I have had a horrible cough for 3 weeks i went to the Er a week ago thinking it was just my asthma when i was told i had acute broncitis. I was given 4 meds. An inhaler,steroids,antibodies,and cough syrup. I took the pills as directed but i became very ill throwing up so i stopped taking them. My cough isnt any better im loosing my voice i have no energy tired often coughing up mucus. And im short of breath. No fun. I guess i should go back to the docs. I hate going to the docs.

  5. May Marfil says:

    Hi, Im three months pregnant and my cough is already 4 weeks, my obgyne have already given me antibiotics though it improve a little yet their is still mucus and it is yellow or green sometimes. Im already disappointed and dont know already what to do. Hope you could give me an advice. Thank you!

  6. Jose Perez says:

    I been having this cough now for the past three weeks, I constantly cough and every time I do its a persistent cough I cough till i start choking and sometimes I cant even breathe in i have to break threw all the mucus for me to continue breathing right again and when i go to bed i wake up in the morning coughing and choking and lose my breathe for a minute. I went to the doctors twice they said it was an infection so they give me some chest pain killers, antibiotics for the infection and promethazine. But these medication ain’t doing any good any advices ?

  7. Rita Gomes says:

    I have a very very bad cough for the last 3and half months I find it hard during the day and more during the night can’t sleep I have to cough out very hard to get relief i urinate sometimesI feel like something always tickling my throat and makes me cough doctor prescribed a ventralior what do you thing it is

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