Honey more effective than dextromethorphan for cough in children

December 4, 2007

By Mary Ann Moon

A bedtime dose of buckwheat honey was more effective than was
dextromethorphan or no treatment at all for quieting cough and facilitating
sleep in children aged 2-17 who had upper respiratory infection, reported
Dr. Ian M. Paul and his associates at Pennsylvania State University,
Hershey.

Honey decreased the frequency, severity, and "bothersome" nature of
children's coughs associated with upper respiratory tract infections, thus
improving both their sleep and their parents' sleep. Dextromethorphan wasn't
any better than no treatment at all in a study comparing the three
strategies.

The findings, combined with those of a previous study by the same
researchers that found that neither dextromethorphan nor diphenhydramine was
superior to placebo for cold symptoms, "now provide a generally safe and
well-tolerated alternative for practitioners to recommend," they wrote in
the December issue of the Archives of Pediatric and Adolescent Medicine.

Dextromethorphan is the most commonly used over-the-counter antitussive for
childhood cough, even though its use is not supported by the American
Academy of Pediatrics or the American College of Chest Physicians. The agent
has been linked to serious adverse events including dystonia, anaphylaxis,
and bullous mastocytosis at standard doses, as well as psychosis, mania,
hallucinations, ataxia, dependence, and death at higher doses.

In contrast, honey, an alternative remedy used by many cultures and endorsed
by the World Health Organization, is generally considered safe - with the
exception of a risk of infantile botulism in children aged under 1 year.
Honey is thought to soothe the throat and to have antioxidant and
antimicrobial effects, although there is "no scientific evidence to support"
its use, Dr. Paul and his associates noted (Arch. Pediatr. Adolesc. Med.
2007;161:1140- 6).

The investigators assessed the two cough remedies against no treatment in
105 patients at a single university-affiliat ed pediatric practice. The
patients were randomly assigned to receive no treatment (37 children),
buckwheat honey (35 children), or a honey-flavored dextromethorphan liquid
(33 children) packaged in identical 10-mL syringes. They were treated for a
single night and assessed via parent interviews before and after the
intervention. The children had a median age of 5 years and had cough or
rhinorrhea for 7 days or fewer before receiving treatment.

Buckwheat honey provided the greatest relief from cough and was
significantly superior to both dextromethorphan and no treatment, the
researchers wrote.

There was no difference in illness duration among the three groups. Parents
reported mild adverse events such as hyperactivity, nervousness, or insomnia
in five children who received honey and two who received dextromethorphan,
compared with none of the children in the no-treatment group. This could
influence physicians' recommendations in some cases, Dr. Paul and his
associates said. Among the limitations of this study noted by the
researchers was that much of the improvement in all groups "can also be
attributed to the natural history of [upper respiratory tract infections],
which generally improve with time and supportive care.

"While additional studies to confirm our findings should be encouraged, each
clinician should consider the findings for honey, the absence of such
published findings for dextromethorphan, and the potential for adverse
effects and cumulative costs associated with dextromethorphan when
recommending treatments for families," they added.

The researchers explained that compared with other types, darker honeys,
such as buckwheat, tend to have more phenolic compounds. These compounds
have been associated with the antioxidant properties of honey that may have
contributed to its relieving effect. Further, they wrote, honey's "topical
demulcent effect may contribute to its benefits for cough as postulated by
the World Health Organization review."