Millions of courses of antibiotics are prescribed for children with acute cough illness each year, despite evidence from randomized, placebo-controlled trials that such treatment is not effective. Evidence that children with cough for ≤10 days should not be treated with antimicrobial agents is presented. Older children with prolonged cough or those with underlying lung disease may benefit from antimicrobial treatment directed specifically at B pertussis, M pneumoniae, C pneumoniae, P aeruginosa, or other specific infections. None of the routinely prescribed cephalosporin or amino penicillin antimicrobials would be effective for these organisms. Noninfectious diagnosis should be sought in children with markedly prolonged cough.

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