# Abnormal Sputum or Phlegm - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - antimicrobial-2023.pdf, Amoxicillin monograph (chapter PDF p339) · Egyptian National Drug Formulary - respiratory-2026.pdf, Salbutamol monograph (chapter PDF p48) · No dose - assessment step, no medicine given · Singh A, Avula A, Zahn E. Acute Bronchitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: March 9, 2024. · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph, Indications naming lower respiratory tract infections, and Dosage Regimen, Adult Dosing: Usual dosage range) · Acute bronchitis - disease-level clinical article (acute-bronchitis-full.txt) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - antimicrobial-2023.pdf, Amoxicillin monograph (chapter PDF p339) - Egyptian National Drug Formulary - respiratory-2026.pdf, Salbutamol monograph (chapter PDF p48) - No dose - assessment step, no medicine given - Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph, Indications naming lower respiratory tract infections, and Dosage Regimen, Adult Dosing: Usual dosage range) - Acute bronchitis - disease-level clinical article (acute-bronchitis-full.txt) ## Treatment metadata - No drug therapy in primary care (Assess first) - Amoxicillin — oral.solid - Salbutamol — oral.inhalation ## Complete treatment card ```text ABNORMAL SPUTUM OR PHLEGM Sources: Egyptian National Drug Formulary - antimicrobial-2023.pdf, Amoxicillin monograph (chapter PDF p339) · Egyptian National Drug Formulary - respiratory-2026.pdf, Salbutamol monograph (chapter PDF p48) · No dose - assessment step, no medicine given · Singh A, Avula A, Zahn E. Acute Bronchitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: March 9, 2024. · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph, Indications naming lower respiratory tract infections, and Dosage Regimen, Adult Dosing: Usual dosage range) · Acute bronchitis - disease-level clinical article (acute-bronchitis-full.txt) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination TESTS (8) - A deep-cough sample early in the morning before eating or drinking, after rinsing the mouth with water for 10 to 15 seconds - Three deep breaths, then cough at 2-minute intervals until sputum comes; 10 to 20 mL is the target volume - Thick sputum is what the laboratory can use - clear runny samples are rejected in many institutions - Tuberculosis needs 3 samples on 3 consecutive days, each returned to the laboratory the same day - A culture is positive if pathogens grow after 24 hours; calling it negative needs 6 weeks in liquid or 6 to 8 weeks in solid media - Acid-fast stain: Mycobacterium tuberculosis retains a red or pink colour - Grocott-Gomori methenamine silver stains fungal organisms, and Pneumocystis jirovecii, black or brown - Normal cytology is a few white cells and no abnormal cells - then something else is causing the symptoms IF NOT THIS - what else fits (2) - Organisms grown from sputum do not always come from the lower respiratory tract; they may be oral flora or contaminants - Cytology is examined for abnormal cells in suspected lung cancer and in some non-cancerous lung conditions Source StatPearls "Sputum Analysis" (NBK563195) - the laboratory chapter; it covers specimen quality and what each test identifies, not a presenting-complaint pathway Status traced to the source above Rx: Main treatment | Suspected bacterial lower respiratory infection - NOT for sputum colour MAIN TREATMENT 1. NO DRUG THERAPY IN PRIMARY CARE (ASSESS FIRST) [1st line] Adult Most discoloured or purulent sputum is viral and needs no antibiotic. Colour alone does not indicate bacterial infection. Assess for fever, focal chest signs, breathlessness and duration before prescribing. - Assess, then decide Peds Same rule in children, and more strongly - antibiotic benefit in an otherwise well child with a productive cough is small. Source No dose - assessment step, no medicine given Why Sputum colour is the commonest reason antibiotics are given when they are not needed. Green sputum reflects neutrophil enzymes, not bacteria, and an antibiotic listed first would make that mistake easier rather than harder. Caution Blood-stained sputum needs separate urgent work-up. Large daily volumes of purulent sputum suggest bronchiectasis. Persistent symptoms with weight loss or night sweats suggest tuberculosis - a live consideration in Egypt. Colour alone is not a reason to prescribe an antibiotic. 2. SALBUTAMOL [add-on - not a substitute] Adult Oral inhalation, one inhalation (100 mcg) or two inhalations up to 4 times a day for persistent symptoms. The maximum daily dose should not exceed 8 inhalations and should usually not be repeated more often than every 4 hours. - As directed, for the duration of cough/wheeze symptoms Peds Under 12 years: One inhalation (100 mcg), or two inhalations, up to 4 times daily. Maximum 800 mcg a day and no more than 6 times in 24 hours. 12 years and over: As for adults. (Children under 12 years: one inhalation (100 mcg) or two inhalations up to 4 times daily, maximum daily dose 800 mcg and no more than 6 times in 24 hours; over 12 years, dose as per adults.) Source Egyptian National Drug Formulary - respiratory-2026.pdf, Salbutamol monograph (chapter PDF p48) Why Salbutamol is formulary-indicated for bronchospasm and chronic bronchitis; it is added alongside the antibiotic to relieve cough and wheeze while the presumed bacterial cause is treated. Caution Inhaled, not swallowed: the dose is the metered-dose inhaler's 100 mcg per actuation. Tremor, tachycardia, and palpitations are common; use with caution in cardiac disease, arrhythmia, and hyperthyroidism. Increasing or excessive use signals poor control and should prompt reassessment rather than repeated escalation. Blood-stained sputum, large-volume purulent sputum, or weight loss/night sweats are red flags needing separate work-up, not just bronchodilator treatment. Egypt AEROLIN 100MCG/DOSE INHALER EIPICO > 3M H... 7.30 EGP BUTALIN 100MCG/ACTUATION 200 DOSES JULPHAR 12.00 EGP SALBOVENT RESPIRATOR 5MG/ML SOLN. 20 ML ALEXANDRIA 17.50 EGP BRONCHOLIN S 0.5% RESPIRATOR SOLN. 30 ML EIPICO 37.00 EGP ALVEOTRACK 5 MG/ML INH. SOLN. 30 ML MDI PHARMA 49.00 EGP VENTAL INHALER 100 MCG/DOSE 200 DOSES ARAB DRUG COMPANY (ADCO) 72.00 EGP VENTOLIN DISKUS 200MCG/DOSE ACCUHALER GLAXO SMITHKLINE 86.00 EGP VENTOLIN EVOHALER 100MCG/ACTUATION INHALER GLAXO SMITHKLINE 86.00 EGP OPICHESTAL SYRUP 120ML EL-OBOUR 2.00 EGP -> ? strength differs, ? different route - not oral.inhalation SALBUTAMOL 2MG/5ML SYRUP 120ML SEDICO 3.50 EGP -> ? strength differs, ? different route - not oral.inhalation SUSPECTED BACTERIAL LOWER RESPIRATORY INFECTION - NOT FOR SPUTUM COLOUR 3. AMOXICILLIN [2nd line] Adult 500 mg to 1 g orally every 8 to 12 hours (immediate-release). - The formulary states no course length for this general range. Its own pneumonia entry is a minimum of 5 days, and that entry has severity criteria this row does not. Peds Mild-moderate infection: 20-40 mg/kg/day divided every 8 hours (max 500 mg/dose) or 25-45 mg/kg/day divided every 12 hours (max 875 mg/dose); severe infection: 80-90 mg/kg/day divided every 12 hours (max 500 mg/dose) - see formulary for the full age- banded table. Source Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph, Indications naming lower respiratory tract infections, and Dosage Regimen, Adult Dosing: Usual dosage range) Why Narrowed in August 2026 to what the documents actually support. The dose claim is sound: the formulary lists lower respiratory tract infection, pneumonia included, among amoxicillin's indications, and gives 500 mg to 1 g of the immediate-release form, taken every 8 to 12 hours, as the usual adult range. The indication claim was the problem - no document here links an antibiotic to abnormal sputum as a symptom, and the card's own cited article says the opposite: pus in the sputum does not by itself mean bacterial infection, and does not by itself call for an antibiotic. So the row is not offered for sputum. It is offered for a suspected bacterial lower respiratory infection, and the role printed on the row reflects that. The formulary attaches no course length to the general range; the pneumonia-specific line was not borrowed, because it carries its own severity criteria. Caution NOT FOR SPUTUM COLOUR. On the article's own reading, purulent sputum need not mean bacterial infection and does not by itself call for an antibiotic - roughly 50% of those with acute bronchitis produce it. The guideline position on the commonest cause of this symptom: the ACCP advises against giving an antibiotic for uncomplicated acute bronchitis in an otherwise healthy adult. When an antibiotic IS indicated: the article restricts it to the case where a treatable pathogen has actually been identified - pertussis being its example. In practice that means fever with focal chest signs, a clear deterioration, or an identified pathogen - not the colour of the sputum. Penicillin allergy is a contraindication - ask about prior reactions before prescribing. Blood-stained sputum needs separate urgent work-up rather than empirical antibiotics alone. A large daily volume of purulent sputum raises the possibility of bronchiectasis and should prompt referral rather than repeated antibiotic courses. Persistent symptoms with weight loss or night sweats need TB work-up before or alongside antibiotic treatment - a live consideration in Egypt. Egypt AMOXYCILLIN 250MG 12 CAPS B.P.2013 ARAB DRUG COMPANY (ADCO) 4.70 EGP (0.39/unit) AMOXICID 250MG 12 CAPS. CID 6.25 EGP (0.52/unit) HICONCIL 250MG 12CAPS. PHARCO 6.50 EGP (0.54/unit) AMOXYCILLIN 500MG 12 CAPS B.P.2013 ARAB DRUG COMPANY (ADCO) 9.00 EGP (0.75/unit) DELPEDOX 875MG 10 F.C.TAB. SEDICO > PIONEER 12.00 EGP (1.20/unit) BIOMOX 500MG 12 CAPS. SEDICO 19.50 EGP (1.62/unit) MOXIPEN 250MG/5ML SUSP. 80ML MISR 9.00 EGP OSPAMOX 1 GM 8 DISPERSABLE TAB. SANDOZ > NOVA... 11.50 EGP HICILLIN 125MG/5ML SUSP. 80ML EL NASR 3.00 EGP -> ? strength differs, ? different route - not oral solid AMOXIL FORT 250MG/5ML SUSP. 60ML MUP > SMITHKL... 5.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)