Efficacy of cough suppressants in children

Taylor, James A.; Novack, Alvin H.; Almquist, Jon R.; Rogers, James E.

doi:10.1016/s0022-3476(06)80031-4

Cited by 120 publications

(75 citation statements)

References 13 publications

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“…With regard to cough suppression, data indicate that codeine-containing products have no benefit over placebo. 29 However, dark-honey-containing products show significant benefit in symptom relief and the AAP supports their use. [30][31][32] Our finding that there was no change in codeine prescribing patterns associated with the 2006 guidelines is in line with previous work showing that practice guidelines have limited impact on provider behavior owing to many factors, including awareness, familiarity, agreement, and self-efficacy.…”

Section: Figurementioning

confidence: 99%

National Patterns of Codeine Prescriptions for Children in the Emergency Department

et al. 2014

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BACKGROUND AND OBJECTIVES: National guidelines have recommended against codeine use in children, but little is known about prescribing patterns in the United States. Our objectives were to assess changes over time in pediatric codeine prescription rates in emergency departments nationally and to determine factors associated with codeine prescription. METHODS: We performed a serial cross-sectional analysis (2001–2010) of emergency department visits for patients ages 3 to 17 years in the nationally representative National Hospital Ambulatory Medical Care Survey. We determined survey-weighted annual rates of codeine prescriptions and tested for linear trends over time. We used multivariate logistic regression to identify characteristics associated with codeine prescription and interrupted time-series analysis to assess changes in prescriptions for upper respiratory infection (URI) or cough associated with two 2006 national guidelines recommending against its use for these indications. RESULTS: The proportion of visits (N = 189 million) with codeine prescription decreased from 3.7% to 2.9% during the study period (P = .008). Odds of codeine prescription were higher for children ages 8 to 12 years (odds ratio [OR], 1.42; 95% confidence interval [1.21–1.67]) and among providers outside the northeast. Odds were lower for children who were non-Hispanic black (OR, 0.67 [0.56–0.8]) or with Medicaid (OR, 0.84 [0.71–0.98]). The 2006 guidelines were not associated with a decline in codeine prescriptions for cough or URI visits. CONCLUSIONS: Although there was a small decline in codeine prescription over 10 years, use for cough or URI did not decline after national guidelines recommending against its use. More effective interventions are needed to prevent codeine prescription to children.

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Section: Figurementioning

confidence: 99%

National Patterns of Codeine Prescriptions for Children in the Emergency Department

et al. 2014

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“…Furthermore, the present study included phytopharmaceuticals, unlike the study performed in the 1980s. et all, 1986Taylor et al, 1993Lee et al, 2000Paul et al, 2004Paul et al, 2007Pavezi, et al, 2001 Randomized Clinical Trial SIETES Paul et al, 2007 Literature Review SIETES Thanacoody, 2007 Regarding the therapeutic classes of the formulations registered in Brazil according to ATC level 4 (Table I), there is a prevalence of other combinations for cough treatment (60.0%), but the following classes are also included: expectorants (15.0%), mucolytics (10%) and other cough suppressants (10%). The most frequent type of combination involves synthetic drugs (47.5%), but there are also combinations of phytopharmaceuticals and synthetic drugs (12.5%) as well as phytopharmaceuticals (2.5%).…”

Section: Discussionmentioning

confidence: 99%

Analysis of the evidence of efficacy and safety of over-the-counter cough medications registered in Brazil

Reis

Figueras

2010

Braz. J. Pharm. Sci.

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The objective of this study was to analyze the level of evidence regarding the efficacy, effectiveness and safety of over-the-counter (OTC) cough medications registered in Brazil. The National Health Surveillance Agency database was used to identify the drugs. Clinical trials, systematic reviews, meta-analyses, and studies on safety were searched on the Medline baseline, the Cochrane Library and SIETES (System of Essential Information in Therapeutics and Health; database in Spanish). Most drugs (62.5%) were sold as a fixed-dose combination of two or more drugs. Randomized clinical trials were found for only three drugs: bromhexine, dextromethorphan and guaifenesin. No clinical trials were found for fixed-dose combinations. Systematic reviews on Cochrane did not report any evidence in favor of or against the effectiveness of cough drugs. Efficacy is also unclear, especially regarding fixed-dose combinations. The evidence for the efficacy of OTC cough medications available in Brazil is poor due to the lack of quality studies. Pharmacovigilance of OTC cough medications should be encouraged. Uniterms:Drugs/utilization studies. Cough. Drugs/nonprescription. Pharmacovigilance. Pharmacoepidemiology.O objetivo deste trabalho foi analisar o nível de evidências sobre a eficácia, a efetividade e a segurança dos medicamentos para tosse registrados no Brasil. A base de dados da Agência Nacional de Vigilância Sanitária foi empregada para identificar os medicamentos. Os ensaios clínicos, as revisões sistemáticas, as metanálises e os estudos de segurança foram pesquisados no Medline, the Cochrane Library e SIETES (Sistema de Informações Essenciais em Terapêutica e Saúde, base de dados em espanhol). A maioria dos medicamentos (62,5%) eram comercializados como associação em dose fixa com dois ou mais fármacos. Ensaios clínicos randomizados foram encontrados apenas para três fármacos: bromexina, dextrometorfano e guaifenesina; para associações a dose fixa não foram encontrados ensaios clínicos. Revisões sistemáticas publicadas pela Cochrane não encontraram evidências favoráveis ou contrárias à efetividade dos medicamentos para tosse. Essa eficácia não é clara, especialmente a das associações a dose fixa. As evidências sobre a eficácia dos medicamentos para tosse isentos de prescrição disponíveis no mercado brasileiro são fracas, devido à falta de pesquisas de boa qualidade. A farmacovigilância de medicamentos para tosse isentos de prescrição deve ser incentivada.Unitermos: Medicamentos/estudos de utilização. Tosse. Medicamentos/isentos de prescrição. Farmacovigilância. Farmacoepidemiologia.

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“…The subjective survey used for this study may also be considered as a limitation, but clinicians and parents often make decisions on the basis of subjective assessment of symptom severity, which has been argued previously. 3,26,27 Some clinicians may express caution about using a product that contains camphor because of the association between toxic ingestions and adverse events such as seizures. [28][29][30][31][32] Historical concerns over the toxicity of camphor centered on the ingestion of camphor as a liquid preparation, camphorated oil, 13,33 and a recent report of seizures was associated with ingestion of illegally sold camphor.…”

Section: Discussionmentioning

confidence: 99%

Vapor Rub, Petrolatum, and No Treatment for Children With Nocturnal Cough and Cold Symptoms

2010

PEDIATRICS

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OBJECTIVE-To determine if a single application of a vapor rub (VR) or petrolatum is superior to no treatment for nocturnal cough, congestion, and sleep difficulty caused by upper respiratory tract infection.METHODS-Surveys were administered to parents on 2 consecutive days-on the day of presentation when no medication had been given the previous evening, and the next day when VR ointment, petrolatum ointment, or no treatment had been applied to their child's chest and neck before bedtime according to a partially double-blinded randomization scheme.RESULTS-There were 138 children aged 2 to 11 years who completed the trial. Within each study group, symptoms were improved on the second night. Between treatment groups, significant differences in improvement were detected for outcomes related to cough, congestion, and sleep difficulty; VR consistently scored the best, and no treatment scored the worst. Pairwise comparisons demonstrated the superiority of VR over no treatment for all outcomes except rhinorrhea and over petrolatum for cough severity, child and parent sleep difficulty, and combined symptom score. Petrolatum was not significantly better than no treatment for any outcome. Irritant adverse effects were more common among VR-treated participants.CONCLUSIONS-In a comparison of VR, petrolatum, and no treatment, parents rated VR most favorably for symptomatic relief of their child's nocturnal cough, congestion, and sleep difficulty caused by upper respiratory tract infection. Despite mild irritant adverse effects, VR provided symptomatic relief for children and allowed them and their parents to have a more restful night than those in the other study groups. Commenting on camphor-containing products, in 1994 the American Academy of Pediatrics Committee on Drugs wrote, "Since alternative agents exist for all indications for camphor therapy, other therapeutic agents that do not contain camphor should be considered." 13 The "alternative agent" for cough and cold symptoms cited by the Committee in 1994, dextromethorphan, was subsequently not recommended by that committee 3 years later in a policy statement on dextromethorphan use. 4 Dextromethorphan continues not to be recommended, 14 and therefore the question of whether clinicians can recommend topical preparations containing camphor, menthol, and eucalyptus oil for URI symptoms in children requires reevaluation. KeywordsWith no contemporary evidence that supports or refutes the efficacy in children with URIs, this study sought to determine if a single application of a vapor rub (VR) or petrolatum is superior to no treatment for nocturnal cough, congestion, and sleep difficulty caused by URIs. We hypothesized that VR or petrolatum would be superior to no treatment for relief of nocturnal symptoms and that VR would be superior to petrolatum. METHODSFrom October 2008 through February 2010, patients were recruited from a universityaffiliated pediatric practice in Hershey, Pennsylvania. Eligible patients were aged 2 to 11 years with symptoms attributed to URIs...

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Efficacy of cough suppressants in children

Cited by 120 publications

References 13 publications

National Patterns of Codeine Prescriptions for Children in the Emergency Department

National Patterns of Codeine Prescriptions for Children in the Emergency Department

Analysis of the evidence of efficacy and safety of over-the-counter cough medications registered in Brazil

Vapor Rub, Petrolatum, and No Treatment for Children With Nocturnal Cough and Cold Symptoms

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