Honey, no antibiotics, recommended for cough

"First use honey for a cough, new guidelines say," reports the BBC, referring to new guidelines on the best ways to treat acute short-term cough.

The guidelines of the National Institute for Health and Care Excellence (NICE) and Public Health England (PHE) have been developed after reviewing the best available scientific evidence.

The evidence showed that honey could be effective in reducing the symptoms of acute cough due to upper respiratory tract infections (respiratory infections), including how often people coughed and how bad their cough was.

The guideline applies to adults and children from the age of 5. It is important to note that honey is not safe for children younger than 1 year.

Other remedies that were also found to be of use were the herbal remedy pelargonium and cough medicines containing either guaifenesin or antitussive dextromethorphan (for people aged 12 years and older).

Most acute coughs are self-limiting viral infections that automatically improve. And antibiotics are not effective in treating viral infections, but can still cause unpleasant side effects.

Antibiotics will usually only be used if people are very unwell or have an increased risk of complications due to an underlying health condition such as cystic fibrosis.

It is important that we only have to use antibiotics when they are really needed. Increasing antibiotic resistance may mean that we may not benefit from these treatments in the future.

Why is the story in the news?

This story has made the news because NICE and PHE have drawn up new guidelines for how doctors should treat acute cough. These guidelines contain clear recommendations for best practices for doctors and other healthcare professionals.

These recommendations are based on the best evidence available at that time. This means that guidelines are updated over the years. The acute cough guideline is still in the design or consultation phase, which means that the recommendations may change slightly based on feedback from specialists, but these are unlikely to change significantly.

What is meant by acute cough?

Acute cough takes a short period (days or weeks, instead of months). This guideline focused on acute cough related to infections of the upper respiratory tract (eg cold or flu), acute bronchitis (temporary infection of the airways that is usually viral) and other lower respiratory tract infections or breast infections (with the exception of pneumonia).

This guideline provides recommendations regarding acute cough in adults, adolescents and children. For children under 5, NICE refers to its guidelines for controlling fever in young children.

What evidence did NICE view?

NICE and PHE have looked at a series of scientific evidence throughout the directive. The preferred choice of the study were randomized, controlled trials, because these are usually the best way to compare different treatments with each other. Other types of research can be used if randomized controlled trials are not available, but these can lead to weaker recommendations.

For all types of research the quality of the research was assessed on the basis of standard criteria. This in turn helped decide how strong the recommendations should be.

Antibiotics can be used to treat infections caused by bacteria. However, most acute coughs are caused by viruses that do not need or respond to antibiotics. Even if a person has a bacterial infection, they can sometimes clean up without needing antibiotics.

As NICE says, when antibiotics are used for acute cough, they do not matter how much the symptoms are, or how long they last. Antibiotics can also have side effects that some people may find unpleasant.

Antibiotics should only be used if the infection is bacterial and does not disappear by itself. A lower threshold for the use of antibiotics can also be used if the person is clearly ill, or for those who have other serious illnesses or weakened immune systems, thus posing a greater risk of complications.

It is important that antibiotics are only used when this is absolutely necessary. This is because bacteria are beginning to develop resistance to antibiotics, which means that these drugs do not work as well as they used to. The more we use them, the bigger this problem will become.

Although researchers are trying to develop new antibiotics, resistance develops faster than we are able to find new treatments. The risk is that we reach a point where we no longer have effective antibiotics to treat infections, and even standard procedures, such as surgery, can become more dangerous in the future.

NICE and PHE found evidence from 3 randomized controlled trials, all of which resembled the use of honey in children and adolescents. In two of the studies it was compared with no treatment and, if necessary, a "supportive treatment" was allowed, including saline (salt water), nasal drops, water vapor and paracetamol.

In both comparisons, children who received honey coughed less often and had less severe cough compared with those who received no treatment. No study found any difference in sleep quality for both children and their adult caregivers. The quality of the evidence found was classified as low to moderate.

This evidence led to NICE and PHE suggesting that honey can be used to relieve cough symptoms, but only in people older than 1 year. It should not be given to children under the age of 1 due to the risks of children's botulism (a rare and severe form of food poisoning that may affect babies). The directive also noted that honey is a sugar and can therefore pose a risk of tooth decay.

How can I use honey to treat a cough?

Although there are many free cough medicines that contain honey, you can also mix them yourself with hot lemon to obtain a similar effect:

  • squeeze half a lemon in a mug of boiled water
  • add 1 to 2 teaspoons of honey
  • drink while it is still warm (do not give small children hot drinks)

The guideline also found evidence to support the use of a number of other remedies that people can use to take care of themselves at home without having to consult a doctor. These include:

  • pelargonium (a herbal remedy, which is thought to be most effective in liquid form)
  • cough medicines that contain expectorant guaifenesin (in people over 12 years of age)
  • cough medicines containing the antitussive dextromethorphan (in people over 12 years of age), as long as the cough is not persistent, such as asthma, or is accompanied by excessive mucus

All these drugs can be used to reduce the symptoms of an acute cough, but will not cure the underlying infection. This is usually better within 3 weeks. If after 3 weeks your cough is not better, you should see your doctor.

Analysis by Bazian

Edited by NHS Website

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