Thursday, November 18, 2010

How efective are children's cough medications?

Upper respiratory infectious are the most common condition in the world and for decades over the counter (OTC) medications have been produced and sold for the relief of the associated symptoms. Because these medications are OTC the FDA has not exercised strict control although in 2007 the FDA did recommend that they not be used for children under six. When we look at the evidence a consistent message emerges relative to the effectiveness of OTC medications for adult and children’s coughs. That message is that they are not effective and could potentially cause harm. There are, however, other more natural approaches that appear to be somewhat effective in relieving the associated symptoms of upper respiratory infections.

A clinical trial comparing honey, dextromethorphan and no treatment found that “…parents rated honey most favorably for symptomatic relief of their child's nocturnal cough and sleep difficulty due to upper respiratory tract infection.” In a more recent trial (November 2010) simple vapor rub, petrolatum and no treatment were compared and the authors concluded that “Despite mild irritant adverse effects, VR provided symptomatic relief for children and allowed them and their parents to have a more restful night than those in the other study groups.” A Cochrane Review of the effectiveness of over the counter medications also concluded that “There is no good evidence for or against the effectiveness of OTC medicines in acute cough”. In yet another study comparing two common medications with no treatment found “Diphenhydramine and dextromethorphan are not superior to placebo in providing nocturnal symptom relief for children with cough and sleep difficulty as a result of an upper respiratory infection. Furthermore, the medications given to children do not result in improved quality of sleep for their parents when compared with placebo. Each clinician should consider these findings, the potential for adverse effects, and the individual and cumulative costs of the drugs before recommending them to families.”

Millions of dollars are spent promoting cough suppressants and other medications for relief of upper respiratory infections and the profits are staggering. Some authors suggest that the use of these products are somewhat engrained in our culture and it will take years of patient education and perhaps more action by the FDA to reduce the risk to society.