Treating Cough and Cold: Guidance for Caregivers of Canadian Youth

Question 1

What is the prevalence of OTC use in kids < age 12?

Answer 1

• 50% kids younger than 12 use one or more OTC products each week
• Cough and cold meds (CCMs) make up the majority of the medication exposures

Question 2

What medications make up CCMs?

Answer 2

• Combination of antitussives, expectorants, antihistamines, decongestants, antipyretics

Question 3

How was pediatric dosing initially created for CCMs?

Answer 3

• Derived from adult doses
• No data supporting their safety and efficacy in pediatric patients
• Effectiveness of CCMs not proven in children

Question 4

What is the evidence for use of CCMs in kids?

Answer 4

• Cochrane review analyzed 8 studies involving 616 kids
• No evidence for or against the use of CCMs in kids or in adults
• End points: Frequency and severity of cough, cough counts, sputum production, physician assessments

Question 5

What is the evidence of harm for CCMs in pediatric patients?

Answer 5

• CCMs responsible for 6% ED visits related to medication use
• 5% patients present with life threatening events showed evidence of CCMs use on toxicology
• CCMs associated with pediatric deaths: 118/189 cases found to be related to CCM ingredients, usually involving either nonprescription drug use or overdose

Question 6

List factors associated with fatalities from OTC CCMs

Answer 6

• Age < 2 years
• Use of the medication for sedation
• Use in a daycare setting
• Combining two or more medications with the same ingredient
• Failure to use a measuring device
• Product misidentification
• Use of products intended for adults

Question 7

What benefits are associated with withdrawal of infant CCMs from the market?

Answer 7

• Decreased ED visits for CM related adverse events in kids < 12 years
• Decrease in annual rates of therapeutic errors in kids < 2 years reported to poison control

Question 8

What does Health Canada recommend for use of CCMs in kids?

Answer 8

• In 2008 advised against use of all CCM formulations in kids < 6 years of age
• FDA recommends CCMs should not be used in kids under tha age of 2

Question 9

What are the recommendations for humidified air?

Answer 9

• Mechanism of action uncetain
• Cochran review unable to recommend its use in treatment of cold symptoms
• No significant adverse events reported

Question 10

What are the recommendations for NSAIDs?

Answer 10

• Cochrane review found NSAIDs did not significantly reduce total symptom score but were found to be beneficial for discomfort or pain caused by the viral illness

Question 11

What are the recommendations for antihistamines?

Answer 11

• Cochrane review found large differences in study designs, participants, interventions and outcomes
• No evidence of any clinically significant effect in general recevery when antihistamines were used as monotherapy
• Small effect on rhinorrhea and sneezing but positive effect overshadowed by sedation
• In older kids and adults see small effect on nasal symptom severity but unclear if these effects were clinically significant

Question 12

What are the recommendations for echinacea?

Answer 12

• 2006 Cochrane review examined 16 studies and found no suffieicnt date to suggest effectiveness of echinacea in kids
• Use of prophylactic echinacea did not result in effective prevention of the common cold

Question 13

What are recommendations about zinc?

Answer 13

• Previously suggested zinc could inhibit viral growth
• Some studies show benefit if zinc is started within 24h of symptom onset, but other studies failed to show such an effect
• At present Zinc not recommended for kids with cough and cold

Question 14

What are recommendations about honey?

Answer 14

• Pasteurized honey can safely be used in kids over the age of 1
• Demulcent effect, antioxidant properties, increases cytokine release
• In paired comparisons significantly superior to no treatment or honey flavoured dextromethorphan
• Cochrane review included one RCT and concluded there was not enough evidence to advise for or against the use of honey
• RCT reported 2.5mL honet before bed improved cough frequency and severity and sleep quality in 60% kids

Question 15

What are recommendations about vitamin C?

Answer 15

• Cochrane review showed no significant improvement of symptoms with vitamin C
• When used as prophylaxis, one study showed reduction in cold duration of 13%
• No clear recommendations around dosing