A Review of the Ingredients Contained in Over the Counter (OTC) Cough Syrup Formulations in Kenya. Are They Harmful to Infants?

Abstract

BackgroundCough syrups are widely used in the developing world, but safety of their use in infants and children less than two years has not been well documented. Some syrups contain multiple combinations of such drugs as promethazine, diphenhydramine and ephedrine; which are individually now contraindicated in children less than two years. Despite this, the syrups are available as over the counter drugs and may be dispensed to mothers who are unaware of the potentially hazardous effects to their infants. A descriptive cross-sectional study was used to investigate suitability of cough syrups sold within Eldoret municipality for use in children less than two years of age based on their formulations and available literature.MethodsTwo semi-structured questionnaires were administered to pharmacy attendants and mothers attending sick child clinic at a referral hospital to establish whether cough syrups containing more than one active ingredient of compounds, now contraindicated in children are administered to infants, and awareness of potential serious adverse effects. Data from labeled contents of cough syrups from retail pharmacies was recorded and corroborated with information from literature to determine those deemed to contain the ingredients. The second questionnaire was administered to mothers with children less than two years to ascertain whether they had used the identified syrups. A total of 260 mothers and 55 pharmacy attendants were interviewed.ResultsThere was widespread use of the syrups in children, including infants, with 192 (74%) of the respondents having used identified syrups and over 90% of these on children less than 2 years including those less than three months.146 (76%) mothers had administered the syrup at double the recommended dose.ConclusionThe regulatory authorities should make concerted efforts to discourage use of cough syrups containing ingredients that pose adverse events to infants, including campaigns to educate pharmacy workers and mothers.

Inappropriate prescription of cough remedies among children hospitalised with respiratory illness over the period 2002–2015 in Kenya

“…This is despite the low cost of cough medicines and continuing aggressive marketing by manufacturers in Kenya, which has been identified as one of the reasons why cough medicines are prescribed. It has also been suggested that health workers have a poor understanding of the ingredients in cough medicines . This suggests that marketing or some perceived benefit of active ingredients where they are known might influence changes in the pattern of active ingredients over time.…”

“…These include the initial introduction and scale up of the Integrated Management of Childhood Illness (IMCI) from 1999, introduction and scale up of Emergency Triage Assessment and Treatment plus admission care (ETAT+) training targeting hospital‐based care from 2006 and efforts at disseminating policy through the media (2009) to discourage prescription of cough mixtures to children . There have, however, been few reports on the use of cough medication in children in the sub‐Saharan region, and most have examined their use in outpatient settings . Three prior studies in Kenyan hospitals using standardised methods and ongoing inpatient surveillance in paediatric wards in 13 Kenyan county hospitals present an opportunity to examine trends in prescription of cough mixtures over the period 2002–2015 in ill children admitted to hospital for whom risks of adverse effects may be higher.…”

A New Generation of Throat Cleaning and Healing Filmogen Solution for the Treatment of Productive (Wet) Cough

“…Cough suppressants are more closely related to expectorants, but instead of making mucus easier to expel, they help stop coughing altogether. Side effects associated with this medication are nausea, nervousness, drowsiness, and dizziness [26]. Antihistamines and corticosteroids are most commonly associated with allergies, but they can also be used in wet cough.…”

An Assessment of Cough Medicine Dispensing Practice to Children Under Two Years Old in Pharmacies in Ho Chi Minh City Using Simulated-Patient Method

“…Beside the lack of carefulness, a poor understanding of the ingredients in cough medicines was suggested as a cause of the inappropriate dispensing decisions (Kigen G. et al, 2015). A study among hospitalized children across Kenyan hospital between 2002 and 2015 showed that educational, policy mass media interventions and an expansion of the pediatric workforce led to the overall decline in the inappropriate use of cough medicines (Mochuki M. et al, 2016).…”