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Three Part Question

In [children with an upper Respiratory Tract Infection (URTI) and cough] is [honey better than standard symptomatic therapy] in regards to [improvement in severity or frequency of the cough]?

Clinical Scenario

A mother brings her 4 year old son to the emergency department with a cough, runny nose, and sore throat for the last 3 days. She requests medicine for the cough which has been keeping them up at night. You wonder if there is sufficient evidence to support the use of honey for the treatment of cough in children with URTIs.

Search Strategy

Medline 1950-04/09 using OVID interface, Cochrane Library (2009), PubMed clinical queries.

[(exp cough/ or cough.mp, or exp common cold/ or common cold.mp, or exp respiratory tract infections/) AND (exp honey/ or honey.mp)]. LIMIT to child (0-18 years), human AND English

Search Outcome

9 papers were found of which 1 was relevant to the three part question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Paul et al. 2007 United States	105 children aged 2 to 18 years with upper respiratory tract infections, nocturnal symptoms, and illness duration of 7 days or less who presented to an outpatient general pediatric practice. A survey was administered to parents on 2 consecutive days, first on the day of presentation when no medication had been given the prior evening and then the next day when honey, honey-flavored Dextromethorphan (DM), or no treatment had been given prior to bedtime. Symptoms were assessed by a parent using a 7 point Likert scale.	Partially double-blinded randomized controlled trial. The no treatment group was not given a placebo.	Cough frequency score improvement	1.89 vs 1.39 vs 0.92 (Honey vs DM vs No Treatment) (p>0.001)	At baseline most symptoms were scored at about 4 (0-6 for most severe). 135 children were enrolled, only 105 completed the survey, the follow up of which was conducted by telephone. Sample size may have been too small to have enough statistical power to detect paired differences between honey and dextromethorphan and dextromethorphan and no treatment.
			Cough severity score improvement	1.80 vs 1.30 vs 1.11 (p>0.001)
			Cough bothersome score improvement	2.23 vs 1.94 vs 1.30 (p>0.001)
			Effect on child sleep improvement	2.49 vs 1.79 vs 1.57 (p>0.001)
			Effect on parent sleep improvement	2.31 vs 1.97 vs 1.51 (p>0.001)
			Combined symptom score improvement	10.71 vs 8.39 vs 6.41 (p>0.001)

Comment(s)

There was only 1 relevant study found. Significant differences were detected in the amount of improvement reported for all of the study outcomes in the 3 way comparison, with honey consistently scoring the best and no treatment scoring the worst. Paired comparisons of honey and dextromethorphan showed no significant differences. Similarly paired comparisons of dextromethorphan and no treatment showed no significant difference. Honey did appear to be superior to no treatment for cough frequency, child sleep, and the combined symptom score. Given the lack of efficacy and adverse side effect profile of dextromethorphan, honey, which is considered safe in children over age 1, may be a suitable alternative.

Clinical Bottom Line

Honey shows early promise as a treatment for the cough and sleep difficulty associated with childhood upper respiratory tract infection.

References

1. Paul IM. Beiler J. McMonagle A. Shaffer ML. Duda L. Berlin CM Jr. Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents Archives of Pediatrics & Adolescent Medicine December 2007; Vol 161 (12), 1140-6