Over-the-counter cough medicines in children: neither safe or efficacious?

Abstract

Patients are encouraged to self-manage acute upper respiratory illness (URTI) and take over-the-counter treatments (OTC) to relieve symptoms rather than attend GPs or seek professional services out of hours.1 One of the most troublesome symptoms of acute URTI is cough, particularly in young children in whom nocturnal symptoms can cause considerable sleep disruption. Understandably, parents have a strong urge to relieve cough in their children with OTC cough medicines, and consumers purchase approximately 95 million of these products per year in the US alone.2 In the UK, there are approximately 24 million episodes of use of OTC cough medicines per year, with children being more likely to be exposed due to their higher frequency of URTI.3 Many different preparations are available for purchase, and the British National Formulary no longer provides a full listing, stating that ‘the rationale for some is dubious’. OTC cough medicines and their combinations of active ingredients vary from simple mucolytics to other active pharmacological agents such as bronchodilators, antihistamines, and centrally-acting cough suppressants. While the use of antihistamines may relieve symptoms in cough related to allergy, there is no rationale for their inclusion in OTC cough medicines targeted at all children, other than enabling suppliers to promote them as an aid to sleep, which, given their potential for misadventure, is inappropriate. There are growing concerns about safety and doubts about the efficacy around the use of OTC cough medicines in children.2,4 This highlights the difficulty in achieving a balance between evidence-based practice, benefits and harms of treatments, and patient self-management. This lack of evidence concerning OTC cough medicines falls into what has been referred …