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Cough & chest infection
Bronchitis vs pneumonia, and the NICE rules on antibiotics.
Typical consult⏱ 15 min
Investigations🔬 Usually none (CXR if pneumonia suspected)
Usual outcome💊 Self-care ± doxycycline
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
1Rule out first — red flags
| If you find… | …then |
|---|---|
| RR ≥ 30, SpO₂ < 92%, confusion, SBP < 90 | Severe pneumonia — CRB-65, ED / admission |
| Haemoptysis, weight loss, smoker over 40, cough > 3 weeks | Lung cancer pathway — CXR / 2-week-wait |
| Pleuritic pain + breathlessness + tachycardia | Consider PE |
| Stridor, unable to complete sentences, silent chest | Airway / severe asthma |
2Focused history
3Focused examination
4Decide — investigate only if it changes the plan
NICE NG120 — acute cough
- Not systemically unwell and not high risk → no antibiotic (self-care)
- Higher risk of complications → consider immediate or back-up antibiotic
- Systemically very unwell → immediate antibiotic
- Pneumonia suspected → CRB-65 and the pneumonia guideline
Acute cough (bronchitis) usually lasts about 3 weeks.
| Investigation | Only if… |
|---|---|
| Chest X-ray | Focal signs, or diagnosis uncertain, or not improving |
| None | For uncomplicated acute bronchitis |
5Treat & send home
Management & advice
- Honey (over 1 year), warm drinks, rest
- Some cough syrups/lozenges may help; avoid codeine linctus
- Stop smoking advice
Refer / follow-up
- CRB-65 ≥ 1 with concern, or ≥ 2 → hospital assessment
- Red flags for cancer → urgent CXR / 2WW
℞
Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.
| Drug | Dose | Duration / notes |
|---|---|---|
| Paracetamol | 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) | As needed |
| Doxycycline (if indicated) | 200 mg on day 1, then 100 mg once a day | 5 days total (not in pregnancy) |
| Amoxicillin (alternative) | 500 mg three times a day | 5 days |
| Clarithromycin (alternative) | 250–500 mg twice a day | 5 days |
6Safety-net
Say it like this
This is a chest infection caused by a virus, so antibiotics won’t help and can cause side effects. A cough like this can last 3 weeks. Honey, warm drinks and paracetamol help. Come back or call 111 if you become short of breath, get chest pain, cough up blood, or feel much worse. If the cough is still there after 3 weeks, see your GP.
Come back / call 111 — or 999 if severe — if:
- Breathless, breathing fast, chest pain, coughing up blood
- Feeling confused, very drowsy or very unwell
- Cough lasting more than 3 weeks
7Patient leaflets — scan & go
Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.
8Document
Cough & chest infection — clinic note
A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.
URGENT CARE — COUGH & CHEST INFECTION
PRESENTING COMPLAINT:
HISTORY
Duration, sputum, fever, breathlessness, chest pain:
Haemoptysis, weight loss, night sweats:
Smoking; asthma/COPD; heart failure:
Higher-risk features: age > 65 with comorbidity, immunosuppression, heart/lung/renal/liver disease:
RED FLAGS (record present / absent)
[ ] RR ≥ 30, SpO₂ < 92%, confusion, SBP < 90
[ ] Haemoptysis, weight loss, smoker over 40, cough > 3 weeks
[ ] Pleuritic pain + breathlessness + tachycardia
[ ] Stridor, unable to complete sentences, silent chest
PMH:
DRUG HISTORY:
ALLERGIES:
SOCIAL (job / who is at home / driving):
OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 )
EXAMINATION
Full obs incl. SpO₂ and RR:
Chest: focal crackles, bronchial breathing, wheeze:
CRB-65: confusion, RR ≥ 30, BP < 90/≤ 60, age ≥ 65:
DECISION RULE — NICE NG120 — acute cough: result ______
INVESTIGATIONS: none required / Chest X-ray, None — result:
IMPRESSION:
PLAN
Treatment / TTO (drug, dose, duration):
Advice given:
Leaflet given (QR / printed): Cough, Chest infection, Antibiotics — when you need them
Follow-up / referral:
SAFETY-NETTING (told to return / call 111 / 999 if):
- Breathless, breathing fast, chest pain, coughing up blood
- Feeling confused, very drowsy or very unwell
- Cough lasting more than 3 weeks
Patient understands and agrees with the plan: Y / N
Seen by: Grade: Date/Time:
✓Guidelines
Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.
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