Microsoft word - chesty cough jan09.doc

Criteria for INCLUSION
Symptomatic relief of productive cough.

Criteria for EXCLUSION
Patients under two years.
Cough productive of green/yellow/blood stained sputum.
Chronic bronchitis.
Asthmatics presenting with wheeze.
Pregnant or breast-feeding patients.
Patients identified as requiring conditional or rapid referral.
Rapid referral
Constant chest pain or chest pain on normal inspiration.
Shortness of breath/difficulty breathing.
Rusty or foul smelling sputum.
Pain related to exertion.
Fever and sweating
Pain or swelling in the calf
Patients experiencing recent sudden weight loss.
Conditional referral
If cough persists beyond two weeks the patient should consult the GP.
Children under 12 years of age if appropriate.
Patients with hepatic or renal impairment, cardiovascular disorders and patients at
risk of seizures if appropriate.

Action for excluded patients
Referral to General Practitioner.
Recommended treatments, frequency of administration and maximum dose
Pseudoephedrine Linctus 30mg/5ml (100ml)
Adults, elderly and children over 12 years: 10ml three times a day.
Children aged 6 to 12 years: 2.5ml to 5ml three times a day. Child 2 to 6 years 2.5ml
three times a day.
Simple Linctus Paediatric (200ml)
Children up to 12 years: 5ml to 10ml three to four times a day
Ammonia and Ipecacuanha Mixture (200ml)
Adults, elderly and children over 12 years: 10ml to 20ml up to a maximum of four
times a day. Contra-indicated in children under 12 years (see note below)
Children under 12 years may be offered advice only or referred to GP as appropriate.
Knowsley PCT Care at the Chemist Treatment Protocols February 2009 Product Reminder
Systemic Decongestants:- Do not use for patients with diabetes, hyperthyroidism,
hypertension, IHD, patients with raised intraocular pressure, prostatic hypertrophy,
hepatic or renal impairment. Do not use in patients taking or have taken MAOIs in the
preceeding 2 weeks. Do not supply during pregnancy or breast-feeding under the
CATC scheme.
Ammonia and Ipecacuanha mixture should not be used in patients under 12 years or
in patients with hepatic or renal impairment, cardiovascular disorders or patients at
risk from seizures.
MHRA advice issued March 2008
National advice on treatment of coughs and colds in children under two was issued in
March 2008. In summary, this advice is:
• Children suffering from a cough or cold should be treated with paracetamol or
ibuprofen to lower the child’s temperature, and if they have a cough to use a simple
cough syrup (such as glycerol, honey or lemon);
• Non-prescription cough and cold preparations containing any of these active
substances should not be used in children under 2 years: Brompheniramine,
Chlorphenamine, Dextrometorphan, Diphenhydramine, Ephedrine, Guaifenesin,
Ipecacuanha, Oxymetazoline, Phenylephrine, Pholcodine, Pseudoephedrine &
• For children aged 2-6 years, care should be taken to adhere to the maximum daily
dose; not to take with other cough and cold medicines; and the advice of a
pharmacist or other healthcare professional should be sought if there are any
Follow-up and advice
Hydration of the airways by maintaining fluid intake and by humidifying inspired air by
using steam inhalations – exercise caution with steam if children are present.
Possible side effects
Large doses of Ipecacuanha or ammonium salts may cause nausea and vomiting,
however these effects would not be expected to occur when this preparation is taken
at the recommended dose.
Knowsley PCT Care at the Chemist Treatment Protocols February 2009


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Prescription Drug Pricing in the United States: Drug Companies Profit at the Expense of Older Americans ______________________________________________________________________________ Minority Staff Special Investigations Division Committee on Government Reform U.S. House of Representatives November 9, 1999 Table of Contents Executive Summary . . . . . . . . . . . . .

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