Brief Answer:
Many coughs are viral in nature.

Detailed Answer:
Dear XXXX,

Thank you very much for the question. At Healthcaremagic.com, we try and resolve your medical queries as completely as possible, but as a disclaimer, let me remind you that this is an online consultation, with no direct examination of your daughter by me, so please bear with me as I ask more questions during the course of this answer.

First of all, as I stated before, up to 60-70% of all "sore throats" are actually viral upper respiratory infections, where antibiotics have no role to play. The following are indicators of the infection being a virus:

a) the cough runs in bouts of 3-5 per spasm
b) fever is mild to moderate, and not above 39 C/102 F
c) when there is no fever, the child is playful, but when fever begins, the child turns pale, lies down or goes to rest, and becomes dull and refuses to eat
d) If blood tests are taken, they show normal to slightly high white-cell counts
e) these coughs take a longer time to go ... up to a week or two

In addition, if the cough is bacterial in nature, the child is very sick, may keep vomiting after the bouts of cough, and has much higher temperatures and throat pain.

The next thing to remember is that sometimes, coughs are not due to infection, but due to allergies, choking on a food item that got stuck in the lungs, change of weather, or other causes.

The upshot of this is that when cough goes beyond four weeks, as seems to be the case with your daughter, you should go in for investigations - tests such as a full blood count, an X-ray of her chest, a consultation by a pediatrician, and additional tests based on your child's specific history, before starting antibiotics. I have seen many children who do not respond to cough medicines, but improve after being given medicines that help to open up the air-passages, such as albuterol.

If your doctor did a correct appraisal of her cough, then Augmentin needs to be given for at least six days - and the relief may occur on the third or fourth day after it has been started. The dose of the medicine is also important. Mild to moderate infections need 25-45 mg/kg body weight/day in 2 divided doses, while we go up to even 90 mg/kg body weight/day in more severe infections.

To summarize:

1. Most coughs are viral and antibiotics don't work.
2. Even if bacterial, we need to treat for at least six days with the right dose of augmentin.
3. Testing is essential in any child whose cough persists beyond 4 weeks despite appropriate treatment.
4. You should consider that the cough may not be due to an infection, but be due to allergies or other causes, where treatment will be different.

I hope this helps. Do revert to me with the following information:

a) Whether she has any allergic component to her cough.
b) Are other family members also allergic - e.g. they have nose allergies, skin allergies, asthma, etc.
c) the results of her blood counts and X-rays
d) What her weight is, and what is the dose of Augmentin she is getting.

Thank you.

Dr. Taher, M. D. Pediatrics.

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