Since 2002, there has been a steady decrease in the number of physician recommendations for cough and cold medicines for children, especially in children aged <2 years, according to a research letter published in JAMA Pediatrics.
In 2008, the US Food and Drug Administration released a public health advisory recommending that children aged <2 years should not take over-the-counter cough and cold medicines. Shortly after, the American Academy of Pediatrics recommended that children aged < 6 years should avoid cough and cold medicines.
Investigators analyzed the trends of physician recommendations for cough and cold medicines and compared these trends with recommendations for antihistamines in the US pediatric population. Measures for cough and cold medicines were categorized by the presence of opioid ingredients; codeine monotherapy was also recorded for visits with respiratory diagnoses.
Of the 3.1 billion pediatric visits over the 14-year analysis, 95.7 million cough and cold medicines were ordered by physicians; 12% of these medicines contained opioids. Compared with rising recommendations for antihistamines, recommendations for both opioid-containing and nonopioid cough and cold medicines declined significantly. Compared with older children, opioid-containing and nonopioid cough and cold medicine recommendations declined even more for children aged <2 years and <6 years, respectively.
The researchers noted, “our findings suggest that physicians’ recommendations of these medicines have steadily declined in the United States since 2002. …However, trends in the recommendations of nonopioid [cough and cold medicine] for children ages 2 to 6 years did not change after 2008 despite changes in labeling and the American Academy of Pediatrics’ effort to limit such use.
“Future work should investigate more recent trends in [cough and cold medicine] use and related outcomes in pediatric populations,” concluded the investigators.
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Horton DB, Gerhard T, Strom BL. Trends in cough and cold medicine recommendations for children in the United States, 2002-2015 [published July 29, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.2252