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Colds and flu

14 August 2019

Are too many kids prescribed antihistamines?

Researchers find that physicians are more likely to recommend antihistamines for children under age 12 with colds, despite the fact that they provide little known benefit.

Many US doctors are much less likely to recommend cough and cold medicines for young children ever since experts advised against it in 2008, new research shows.

That's the good news. The bad news?

Sleepy vs. hyper

Physicians are still more likely to recommend antihistamines for children under age 12 with colds, despite the fact that they provide little known benefit, the researchers from Rutgers University in New Jersey said.

"Sedating antihistamines such as diphenhydramine [Benadryl] may have a small effect on some cold symptoms in adults," said study lead author Dr Daniel Horton. He is an assistant professor of paediatrics at Rutgers Robert Wood Johnson Medical School.

"However, there is little evidence that antihistamines actually help children with colds feel better or recover faster. We do know that these medicines can make kids sleepy and some kids quite hyper," Horton said in a university news release.

Just over a decade ago, the US Food and Drug Administration recommended against cough and cold medicines for children under age two due to safety concerns and uncertain benefits. The American Academy of Pediatrics later advised against cough and cold medicines in children under age six.

"Families often treat their children's respiratory infections with cough and cold medicines, some of which include opioid ingredients, such as codeine or hydrocodone. However, there is little proof that these medications effectively ease the symptoms in young children," Horton explained.

Antihistamines not necessarily an improvement

"Also, many cough and cold medicines have multiple ingredients, which increases the chance of serious accidental overdose when combined with another product," he added.

In the study, the researchers analysed more than three billion visits by children to US clinics and emergency departments from 2002 to 2015. They found that physicians ordered a total of about 95.7 million cough and cold medications, 12% of which contained opioids.

After the FDA's advisory, there was a 56% drop in physician recommendations for non-opioid cough and cold medicines in children under two and a 68% decrease in recommendations for opioid-containing medicines in children under six.

Yet the researchers also found a 25% increase in doctor recommendations for antihistamines to treat respiratory infections in children under 12.

"It is nice to see physicians are heeding the advice to avoid cough and cold medications for children, but switching them to antihistamines is not necessarily an improvement," said study co-author Dr Brian Strom, chancellor of Rutgers Biomedical and Health Sciences.

The study was published in the journal JAMA Pediatrics.

Image credit: iStock

 

Ask the Expert

Flu expert

Dr Heidi van Deventer completed her MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 2004 at the University of Stellenbosch.
She has additional training in ACLS (Advanced Cardiac Life Support) and PALS (Paediatric Advanced Life Support) as well as biostatistics and epidemiology.

Dr Van Deventer is currently working as a researcher at the Desmond Tutu Tuberculosis Centre at the University of Stellenbosch.

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