In a randomized trial honey wins over other cough medications

A bit of buckwheat honey before bedtime may be the treatment of choice for a young child with a cough, suggested a randomized trial here.

In a three-way comparison, honey was significantly more effective than no treatment (P<0.001) for relief of symptoms, and dextromethorphan was not, Ian M. Paul, M.D., of Penn State, and colleagues, reported in the December issue of Archives of Pediatrics and Adolescent Medicine.

"Honey may be a preferable treatment for the cough and sleep difficulty associated with childhood upper respiratory tract infection," they concluded.

In the study of 105 children, a half teaspoon to two teaspoons of buckwheat honey led to overall symptom severity scores of about nine on the second night, compared with 11 for honey-flavored dextromethorphan and 13 for no treatment at all, the investigators said.

"All of the outcomes found honey to yield the greatest improvement, followed by dextromethorphan, while no treatment consistently showed the least amount of improvement," the authors wrote. "For cough frequency, those who received honey had a mean 1.89-point improvement as rated by their parents compared with a 1.39-point change for those receiving dextromethorphan and a 0.92-point change for those who had no treatment on the second night (P<0.001).

They found that dextromethorphan was not significantly better than no treatment for any study outcome. "Similarly, pairwise comparison of honey with dextromethorphan revealed no statistically significant differences," the group said.

In an accompanying editorial, a group led by Michael D. Warren, M.D., of Vanderbilt, noted that "honey is generally affordable and often cheaper than OTC antitussives and has a low risk profile when used in patients older than one year. Processed honey is rarely associated with allergic reactions, although such reactions are more likely in persons with pollen allergy."

In the randomized trial, the difference between honey and no treatment was significant (P<0.001). Significant differences between honey and no treatment were also found for every individual symptom: cough frequency, cough severity, annoyance to child, child's sleep, and parents' sleep (P<0.001 for all).

"Dextromethorphan continues to be used very frequently in the United States despite numerous studies, evidence-based reviews, and policy statements describing its lack of efficacy," the group wrote.

"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 the use of dextromethorphan when recommending treatments for families," the investigators said.

The new study enrolled children with a mean age of about five years who had coughs lasting a week or less because of upper respiratory infections. Those with possibly more treatable conditions, as well as those with asthma or other chronic lung conditions, were excluded.

Active-treatment doses were scaled according to age. Those ages two to five received half a teaspoon, ages six to 11 received one teaspoon and ages 12 to 18 received two teaspoons. Dextromethorphan was prepared at 17 mg/5 ml. Children and their parents did not know whether they were receiving honey or dextromethorphan, but those assigned to no treatment were aware of it.

Outcomes were assessed by parents. They completed a questionnaire at enrollment on symptoms the previous night, which was repeated the next day after the children had taken a dose of dextromethorphan or honey, or remained untreated.

The study could not determine why honey would be effective, but the authors cited other research finding that honey contains antioxidant and antimicrobial compounds that conceivably could have an effect on cough symptoms. Dark honeys, including the buckwheat honey used in this study, appear to be relatively rich in these compounds.

-Honey Soothes the Coughing Child