Dr Phil Kieran: Does my child need a second antibiotic?

A persistent cough after a respiratory infection can be one of the most irritating things to deal with. Picture: iStock 

The whole family was sick with chest infections before Christmas. We got through with the help of antibiotics. My youngest child, aged 11, hasn’t fully recovered and occasionally has coughing fits. Should I ask the doctor for a second round of antibiotics, or would it be better to let nature take its course?

A persistent cough after a respiratory infection can be one of the most irritating things to deal with. Unfortunately, it can take children longer to recover from it than it does for adults.

When we get respiratory infections, the lining of the airways can become irritated, triggering an exaggerated cough reflex, leading to fits of coughing as you describe. It is normal for this to take up to three weeks to settle down and it isn’t unusual for it to last twice this long in some people.

Many conditions can prolong recovery from a chest infection, including asthma, allergies, and rhinitis (excessive mucus production in the sinuses or nose), and picking apart this confusing web can be very tricky.

In your son’s case, I certainly wouldn’t be asking for another course of antibiotics, as the initial bacterial infection is likely cleared, and repeating the prescription isn’t going to help.

Frequently, I talk to people who feel the course of antibiotics should be longer than the one they received, but I point out that antibiotics are meant to help the immune system clear the infection. The full recovery often happens only with time. In fact, some guidelines recommend antibiotics be given for only five days rather than the traditional seven.

It may be worth bringing your son to the GP to have him reassessed and examined again to see if there is a different reason for his cough persisting.

This could be a new infection — in which case another course of antibiotics may be warranted — or it could be asthma or allergies. Each of these diagnoses would have different advice.

If his cough is slowly improving, either with each episode becoming less severe or the episodes themselves gradually becoming less frequent, then I suspect this is a post-infectious cough, and no medication will help to speed up his recovery.

What can be of help, particularly if he finds the cough distressing, is a teaspoon of honey in warm water. A medical trial shows that this is as effective as most cough bottles on the market. It is often more palatable, too.

After an infection, our body needs to heal, and this is a complex, individual process that, unfortunately, takes as long as it takes.

Definitely go to your doctor if you are concerned that he is either not improving at all or getting worse, but I would be relieved rather than frustrated if they tell you he doesn’t need any medication at this point.

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