title: A Review of the Ingredients Contained in Over the Counter (OTC) Cough Syrup Formulations in Kenya. Are They Harmful to Infants?
abstract: BACKGROUND
  Cough 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.
  
  
  METHODS
  Two 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.
  
  
  RESULTS
  There 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Kigen
authors.affiliation: Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Naftali
authors.initials: N
authors.lastname: Busakhala
authors.affiliation: Department of Paediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Francis
authors.initials: F
authors.lastname: Ogaro
authors.affiliation: Department of Paediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Emily
authors.initials: E
authors.lastname: Chesire
authors.affiliation: Department of Pharmacy, Moi University Health Services, Eldoret, Kenya.
authors.forename: Nathan
authors.initials: N
authors.lastname: Saat
authors.affiliation: Department of Epidemiology and Nutrition, Moi University School of Public Health, Eldoret, Kenya.
authors.forename: Robert
authors.initials: R
authors.lastname: Too
authors.affiliation: Department of Child Health and Pediatrics, Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Winstone
authors.initials: W
authors.lastname: Nyandiko
mesh_terms: D000996:Antitussive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D002675:Child, Preschool; D003371:Cough / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005100:Expectorants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006634:Histamine H1 Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007630:Kenya; D008297:Male; D004366:Nonprescription Drugs / Q000009:adverse effects* / Q000627:therapeutic use*; D010594:Pharmacies; D011398:Promethazine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000996:Antitussive Agents; D005100:Expectorants; D006634:Histamine H1 Antagonists; D004366:Nonprescription Drugs; D011398:Promethazine