Cochrane in context: Honey for acute cough in children

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Background Cough causes concern for parents and is a major cause of outpatient visits. It can impact on quality of life, cause anxiety and affect parents' and children's sleep. Several remedies, including honey, have been used to alleviate cough symptoms.

Objectives To evaluate the effectiveness of honey for acute cough in children in ambulatory settings.

Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2011) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1950 to December week 4, 2011); EMBASE (1990 to January 2012); CINAHL (1981 to January 2012); Web of Science (2000 to January 2012); AMED (1985 to January 2012); LILACS (1982 to January 2012) and CAB abstracts (2009 to January 2012).

Selection criteria Randomized controlled trials comparing honey given alone, or in combination with antibiotics, versus nothing, placebo or other over-the-counter cough medications to participants aged 2–18 years for acute cough in ambulatory settings.

Data collection and analysis Two review authors independently screened search results for eligible studies and extracted data on reported outcomes.

Main results We included two randomized controlled trials of high risk of bias involving 265 children. The studies compared the effect of honey with dextromethorphan, diphenhydramine and 'no treatment' on symptomatic relief of cough using the 7-point Likert scale.

Honey was better than 'no treatment' in reducing frequency of cough (mean difference: −1.07; 95% confidence interval: −1.53 to −0.60; two studies; 154 participants). Moderate quality evidence suggests that honey did not differ significantly from dextromethorphan in reducing cough frequency (mean difference: −0.07; 95% confidence interval: −1.07 to 0.94; two studies; 149 participants). Low quality evidence suggests that honey may be slightly better than diphenhydramine in reducing cough frequency (mean difference: −0.57; 95% confidence interval: −0.90 to −0.24; one study; 80 participants).

Adverse events included mild reactions (nervousness, insomnia and hyperactivity) experienced by seven children (9.3%) from the honey group and two (2.7%) from the dextromethorphan group; the difference was not significant (risk ratio: 2.94; 95% confidence interval: 0.74–11.71; two studies; 149 participants). Three children (7.5%) in the diphenhydramine group experienced somnolence (risk ratio: 0.14; 95% confidence interval 0.01–2.68; one study; 80 participants) but there was no significant difference between honey versus dextromethorphan group and honey versus diphenhydramine group. No adverse event was reported in the 'no treatment' group.

Author's conclusions Honey may be better than 'no treatment' and diphenhydramine in the symptomatic relief of cough but not better than dextromethorphan. There is no strong evidence for or against the use of honey.

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