title: Honey for acute cough in children.
abstract: BACKGROUND
  Cough causes concern for parents and is a major cause of outpatient visits. It can impact on quality of life, cause anxiety and affect sleep in parents and children. Several remedies, including honey, have been used to alleviate cough symptoms.
  
  
  OBJECTIVE
  To evaluate the effectiveness of honey for acute cough in children in ambulatory settings.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2011) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1950 to December week 4, 2011); EMBASE (1990 to January 2012); CINAHL (1981 to January 2012); Web of Science (2000 to January 2012); AMED (1985 to January 2012); LILACS (1982 to January 2012); and CAB abstracts (2009 to January 2012).
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing honey given alone, or in combination with antibiotics, versus nothing, placebo or other over-the-counter (OTC) cough medications to participants aged from two to 18 years for acute cough in ambulatory settings.
  
  
  METHODS
  Two review authors independently screened search results for eligible studies and extracted data on reported outcomes.
  
  
  RESULTS
  We included two RCTs of high risk of bias involving 265 children. The studies compared the effect of honey with dextromethorphan, diphenhydramine and 'no treatment' on symptomatic relief of cough using the 7-point Likert scale.Honey was better than 'no treatment' in reducing frequency of cough (mean difference (MD) -1.07; 95% confidence interval (CI) -1.53 to -0.60; two studies; 154 participants). Moderate quality evidence suggests honey did not differ significantly from dextromethorphan in reducing cough frequency (MD -0.07; 95% CI -1.07 to 0.94; two studies; 149 participants). Low quality evidence suggests honey may be slightly better than diphenhydramine in reducing cough frequency (MD -0.57; 95% CI -0.90 to -0.24; one study; 80 participants).Adverse events included mild reactions (nervousness, insomnia and hyperactivity) experienced by seven children (9.3%) from the honey group and two (2.7%) from the dextromethorphan group; the difference was not significant (risk ratio (RR) 2.94; 95% Cl 0.74 to 11.71; two studies; 149 participants). Three children (7.5%) in the diphenhydramine group experienced somnolence (RR 0.14; 95% Cl 0.01 to 2.68; one study; 80 participants) but there was no significant difference between honey versus dextromethorphan or honey versus diphenhydramine. No adverse event was reported in the 'no treatment' group.
  
  
  CONCLUSIONS
  Honey may be better than 'no treatment' and diphenhydramine in the symptomatic relief of cough but not better than dextromethorphan. There is no strong evidence for or against the use of honey.
authors.affiliation: Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital (ITDR/P), Calabar, Nigeria. olabisioduwole@yahoo.co.uk
authors.forename: Olabisi
authors.initials: O
authors.lastname: Oduwole
authors.forename: Martin M
authors.initials: MM
authors.lastname: Meremikwu
authors.forename: Angela
authors.initials: A
authors.lastname: Oyo-Ita
authors.forename: Ekong E
authors.initials: EE
authors.lastname: Udoh
mesh_terms: D000293:Adolescent; D000996:Antitussive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D056705:Apitherapy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000628:therapy*; D003915:Dextromethorphan / Q000009:adverse effects / Q000627:therapeutic use*; D006722:Honey / Q000009:adverse effects; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D000996:Antitussive Agents; D003915:Dextromethorphan