Honey for acute cough in children

Olabisi Oduwole; Martin M Meremikwu; Angela Oyo‐Ita; Ekong E Udoh

doi:10.1002/14651858.CD007094.pub4

Mel para tosse aguda em crianças

Contraer todo Desplegar todo

Referencias

References to studies included in this review

Ir a:

estudios excluidos
estudios a la espera de valoración
estudios en curso
otras referencias
otras versiones publicadas

Cohen HE, Rozen J, Kristal H, Laks Y, Berkovitch M, Uziel Y, et al. Effect of honey on nocturnal cough and sleep quality: a double‐blind, randomised, placebo‐controlled study. Pediatrics 2012;130(3):465‐71. [DOI: 10.1542/peds.2011‐3075]

Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Archives of Pediatrics and Adolescents Medicine 2007;161(12):1140‐6. [NCT00127686:]

Shadkam MN, Mozaffari‐Khosravi H, Mozayan MR. A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents. Journal of Alternative and Complimentary Medicine 2010;16(7):787‐93. [DOI: 10.1089/acm.2009.0311]

References to studies excluded from this review

Ir a:

estudios incluidos
estudios a la espera de valoración
estudios en curso
otras referencias
otras versiones publicadas

Ahmed N, Sutcliffe A, Tipper C. Feasibility study: honey for treatment of cough in children. Pediatric Reports 2013;5(e8):31‐4. [DOI: 10.4081/pr.2013.e8]

Gilbert G. Single dose of honey effective for cough in kids. Journal of the National Medical Association 2008;100(4):459.

Google Scholar

Miceli Sopo S, Greco M, Monaco S, Varrasi G, Di Lorenzo G, Simeone G, for the Milk Honey Study (M&HS) Group. Effect of multiple honey doses on non‐specific acute cough in children. An open randomised study and literature review. Allergologia et Immunopathologia 2014 Sep 5 [Epub ahead of print].

Warren MD, Pont SJ, Barkin SL, Callahan ST, Caples TL, Carroll KN, et al. The effect of honey on nocturnal cough and sleep quality for children and their parents. Archives of Pediatrics and Adolescent Medicine 2007;161(12):1149‐53.

References to studies awaiting assessment

Ir a:

estudios incluidos
estudios excluidos
estudios en curso
otras referencias
otras versiones publicadas

IRCT201110247882N1. Comparison study of honey versus diphenhydramine effect on cough alleviation in 2‐5 years old children with viral upper respiratory tract infection. http://www.irct.ir/searchresult.php?id=7882&number=1 (accessed 04 November 2014).

NCT01356693. Randomized, double‐blind, placebo‐controlled clinical trial to evaluate the efficacy of the phytotherapic compound "Bromelin" on acute irritative cough. https://clinicaltrials.gov/ct2/show/NCT01356693 (accessed 04 November 2014).

References to ongoing studies

Ir a:

estudios incluidos
estudios excluidos
estudios a la espera de valoración
otras referencias
otras versiones publicadas

IRCT2014090819037N1. Comparison of the effect of two kinds of Iranian honey and diphenhydramine on nocturnal cough and sleep quality in coughing children and their parents. http://apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2014090819037N1 (accessed 04 November 2014).

Additional references

Ir a:

estudios incluidos
estudios excluidos
estudios a la espera de valoración
estudios en curso
otras versiones publicadas

Abramson JH, Gahlinger PM. Computer Programs for Epidemiologists: PEPI version 3. Llanidloes: Brixton Books, 1999.

Google Scholar

Adeleye IA, Opiah L. Antimicrobial activities of local cough mixtures on upper respiratory tract bacterial pathogens. West Indian Medical Journal 2003;52(3):188‐90.

Google Scholar

Agbaje EO, Ogunsanya T, Aiwerioba OR. Conventional use of honey as antibacterial agent. Annals of African Medicine 2006;5(2):78‐81.

Google Scholar

Banderali G, Riva E, Fiocchi A, Cordaro CI, Giovannini M. Efficacy and tolerability of levodropropizine and dropropizine in children with non‐productive cough. Journal of International Medical Research 1995;23:175‐83.

Braman SS. Postinfectious cough: ACCP evidence‐based clinical guidelines. Chest 2006;129(Suppl 1):138‐46.

Google Scholar

Butler CC, Hood K, Kinnersley P, Robling M, Prout H, Houston H. Predicting the clinical course of suspected acute viral upper respiratory tract infection in children. Family Practice 2005;22(1):92‐5.

Centers for Disease Control and Prevention. Infant death associated with cough and cold medications ‐ two states, 2005. Morbidity and Mortality Weekly Report 2007;56(1):1‐4.

PubMed

Chang AB. Cough: are children really different to adults?. Cough 2005;1:7.

Chang CC, Cheng AC, Chang AB. Over‐the‐counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. Cochrane Database of Systematic Reviews 2014, Issue 3. [DOI: 10.1002/14651858.CD006088.pub4]

Cherry DK, Burt CW, Woodwell DA. National ambulatory medical care survey. Advance Data 2003;337:1‐44.

Google Scholar

Dicpinigaitis PV, Colice GL, Goolsby MJ, Rogg GI, Spector SL, Winther B. Acute cough: a diagnostic and therapeutic challenge. Cough 2009;5:11. [DOI: doi:10.1186/1745‐9974‐5‐11]

El‐Gindy A, Emara S, Mesbah MK, Hadad GM. Liquid chromatography and chemometric‐assisted spectrophotometric methods for the analysis of two multicomponent mixtures containing cough suppressant drugs. Journal of AOAC International 2005;88(4):1069‐80.

Fisher RA. The interpretation of chi square from contingency tables, on the calculation of P. Journal of the Royal Statistical Society 1922;85(1):87‐94.

Freestone C, Eccles R. Assessment of the antitussive efficacy of codeine in cough associated with common cold. Journal of Pharmacy and Pharmacology 1997;49(10):1045‐9.

French CL, Irwin RS, Curley FJ, Krikorian CJ. Impact of chronic cough on quality of life. Archives of Internal Medicine 1998;158(15):1657‐61.

French CT, Irwin RS, Fletcher KE, Adam TM. Evaluation of a cough‐specific quality‐of‐life‐questionnaire. Chest 2002;121(4):1123‐31.

Garedew A, Schmolz E, Lamprecht I. Microcalorimetric investigation on the antimicrobial activity of honey of the stingless bee Trigona spp. and comparison of some parameters with those obtained with standard methods. Thermochimica Acta 2004;415(1‐2):99‐106.

Golob T, Dobersek U, Kump P, Necemer M. Determination of trace and minor elements in Slovenian honey by total reflection x‐ray fluorescence spectroscopy. Food Chemistry 2005;91(4):593‐600.

Gonzales R, Sande MA. Uncomplicated acute bronchitis. Annals of Internal Medicine 2000;133(12):981‐91.

Greaves I, Porter K, Hodgetts T, Woollard M. Emergency Care: A Textbook for Paramedics. www.books.google.com/books (accessed 21 June 2007). [ISBN 0702019755]

Gunn VL, Taha SH, Liebelt EL, Serwint JR. Toxicity of over‐the‐counter cough and cold medications. Pediatrics 2001;108(3):e52.

Havsteen BH. The biochemistry and medical significance of the flavonoids. Pharmacology and Therapeutics 2002;96(2‐3):67‐202.

Hay AD, Wilson A, Fahey T, Peters TJ. The duration of acute cough in pre‐school children presenting to primary care: a prospective cohort study. Family Practice 2003;20(6):696‐705.

Hermosin I, Chicon RM, Cabezudo MD. Free amino acid composition and botanical origin of honey. Food Chemistry 2003;83(2):263‐8.

Hernández OM, Fraga JMG, Jiménez AI, Jiménez Fand Arias JJ. Characterization of honey from the Canary Islands: determination of the mineral content by atomic absorption spectrophotometry. Food Chemistry 2005;93(3):449‐58.

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Kelly LF. Pediatric cough and cold preparations. Pediatrics in Review 2004;25(4):115‐23.

Kurth W. Secure therapeutic effectiveness of the traditional antitussive agent Mintetten in a double‐blind study [Gesicherte therapeutische wirksamkeit des traditionellen antitussivums mintetten im doppelblindversuch]. Medizinische Welt 1978;29(48):1906‐9.

Google Scholar

Kusel MM, De Klerk N, Holt PG, Landau Ll, Sly PD. Occurrence and management of acute respiratory illnesses in early childhood. Pediatric Infectious Disease Journal 2007;43(3):139‐46.

Küplülü O, Göncüoglu M, Özdemir H, Koluman A. Incidence of Clostridium botulinum spores in honey in Turkey. Food Control 2006;17(3):222‐4.

Landau LI. Acute and chronic cough. Paediatric Respiratory Reviews 2006;7(1):64‐7.

Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Likert R. A technique for measurement of attitude. Archives of Psychology 1932;140:1‐55.

Google Scholar

Lusby PE, Coombes AL, Wilkinson JM. Bactericidal activity of different honeys against pathogenic bacteria. Archives of Medical Research 2005;36(5):464‐7.

Meyer AA, Aitken PV. Evaluation of persistent cough in children. Primary Care 1996;23(4):887‐92.

Molan PC. The evidence supporting the use of honey as a wound dressing. International Journal of Lower Extremity Wounds 2006;5(1):40‐54.

Morice A, Abdul‐Manap R. Drug treatments for coughs and colds. Prescriber 1998;17(9):74‐9.

Google Scholar

Mullai V, Menon T. Bactericidal activity of different types of honey against clinical and environmental isolates of Pseudomonas aeruginosa. Journal of Alternative and Complementary Medicine 2007;13(4):439‐41.

Nagai T, Inoue R, Kanamori N, Suzuki N, Nagashima T. Characterization of honey from different floral sources. Its functional properties and effect of honey species on storage meat. Food Chemistry 2006;97(2):256‐62.

Nanda V, Sarkar BC, Sharma HK, Bawa AS. Physico‐chemical properties and estimation of mineral content in honey produced from different plants in Northern India. Journal of Food Composition and Analysis 2003;16(5):613‐9.

Nevas M, Heilm S, Lindstrom M, Horn H, Koivulehto K, Korkeala H. High prevalence of Clostridium botulinum types A and B in honey samples detected by polymerase chain reaction. International Journal of Food Microbiology 2002;72(1‐2):45‐52.

The Proprietary Association of Great Britain. Annual Review and Report. The Proprietary Association of Great Britain. London: PAGB, 2000.

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

Sanz ML, Gonzalez M, De Lorenzo C, Sanz J, Matinez‐Castro I. Carbohydrate composition and physico chemical properties of artisanal honeys from Madrid (Spain): occurrence of Echium sp. honey. Journal of the Science of Food and Agriculture 2004;84(12):1577‐84.

Smith MBH, Feldman W. Over‐the‐counter cold medications. A critical review of clinical trials between 1950 and 1991. JAMA 1993;269(17):2258‐63.

Smith SM, Schroeder K, Fahey T. Over‐the‐counter (OTC) medications for acute cough in children and adults in ambulatory settings. Cochrane Database of Systematic Reviews 2012, Issue 8. [DOI: 10.1002/14651858.CD001831.pub4]

Suárez‐Luque S, Mato I, Huidobro JF, Simal‐Lozano J, Sancho MT. Rapid determination of minority organic acids in honey by high‐performance liquid chromatograghy. Journal of Chromatograghy 2002;955(2):207‐14.

Tonks AJ, Cooper RA, Jones KP, Blair S, Parton J, Tonks A. Honey stimulates inflammatory cytokine production from monocytes. Cytokine 2003;21(5):242‐7.

Tuzen M, Silici S, Mendil D, Soylak M. Trace element levels in honeys from different regions of Turkey. Food Chemistry 2007;103:2.

Yao L, Datta N, Tomas‐Barberan FA, Ferreres F, Martos I, Singanusong R. Flavonoids, phenolic acids and abscisic acid in Australian and New Zealand leptospermum honeys. Food Chemistry 2003;81(2):159‐68.

Zeina B, Othman O, Al‐Assad S. Effects of honey versus thyme on rubella virus survival in vitro. Journal of Alternative and Complementary Medicine 1996;2(3):345‐8.

References to other published versions of this review

Ir a:

estudios incluidos
estudios excluidos
estudios a la espera de valoración
estudios en curso
otras referencias

Oduwole O, Meremikwu MM, Oyo‐Ita A, Udoh EE. Honey for acute cough in children. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD007094]

Oduwole O, Meremikwu MM, Oyo‐Ita A, Udoh EE. Honey for acute cough in children. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD007094.pub2]

Oduwole O, Meremikwu MM, Oyo‐Ita A, Udoh EE. Honey for acute cough in children. Cochrane Database of Systematic Reviews 2012, Issue 3. [DOI: 10.1002/14651858.CD007094.pub3]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

estudios excluidos
estudios a la espera de clasificación
estudios en curso

Cohen 2012

Methods	RCT
Participants	300 children (75 allocated to each treatment arm of eucalyptus honey, citrus honey, labiatae honey and placebo); 1 to 5 years with URTIs, nocturnal cough and illness duration of 7 days or less, attending general paediatric community clinics
Interventions	Single dose of 10 g of eucalyptus honey, citrus honey, labiatae honey or placebo administered 30 minutes before bedtime
Outcomes	Cough frequency, cough severity, bothersome nature of cough, child and parent sleep quality
Notes	This study was supported in part by a research grant from Israel Ambulatory Paediatric Association, Maternal Infant Nutrition Research Institute and the Honey board of Israel
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	The 3 honeys and the placebo were prepared by someone not involved in the study, interventions were packed in small plastic containers marked A, B, C and D and distributed to the paediatric community clinics in blocks of 4
Allocation concealment (selection bias)	Low risk	Silan date extract was used by the authors as a placebo because its structure, brown colour and taste are similar to that of honey. Interventions were packed in plastic containers labelled with the letters A, B, C and D
Blinding (performance bias and detection bias) change in cough frequency	Low risk	The parents, physicians and investigators did not know the content of the preparation that was dispensed. The envelopes containing the codes for the study preparations were stored at the office of the Ministry of Agriculture, Extension service, Bee keeping Department and were not opened until after the statistical analysis was completed
Blinding (performance bias and detection bias) the effect of the cough on sleep of the child	Low risk	The parents, physicians and investigators did not know the content of the preparation that was dispensed. The envelopes containing the codes for the study preparations were stored at the office of the Ministry of Agriculture, Extension service, Bee keeping Department and were not opened until after the statistical analysis was completed
Blinding (performance bias and detection bias) the effect of cough on sleep of parents	Low risk	The parents, physicians and investigators did not know the content of the preparation that was dispensed. The envelopes containing the codes for the study preparations were stored at the office of the Ministry of Agriculture, Extension service, Bee keeping Department and were not opened until after the statistical analysis was completed
Selective reporting (reporting bias)	Low risk	All outcomes were adequately reported
Other bias	Unclear risk	Participants lost to follow‐up or withdrawn were not included in the final analysis
Follow‐up	Low risk	14, 13, 2 and 4 participants were lost to follow‐up in the eucalyptus honey, citrus honey, labiatae honey and placebo group respectively because they discontinued the intervention

Paul 2007

Methods	RCT
Participants	108 participants (35 allocated to honey, 34 allocated to dextromethorphan and 39 who received 'no treatment'); 2 to 18 years of age with URTIs, nocturnal symptoms and illness duration of 7 days or less
Interventions	A single dose of buckwheat honey, honey flavoured dextromethorphan or 'no treatment' administered 30 minutes prior to bedtime
Outcomes	Cough frequency, cough severity, bothersome nature of cough, cough impact on sleep quality for children and parents
Notes	This study was supported by an unrestricted research grant from the National Honey Board, an industry‐funded agency of the United States Department of Agriculture. It is possible that participants in the 'no treatment' group showed the least improvement because they were aware that they did not receive the active treatment, which could have been a source of bias in their responses
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	The randomisation sequence was done by a statistician not affiliated with the study and was then used by the study co‐ordinators to assign the treatment groups
Allocation concealment (selection bias)	Low risk	Treatment allocation was concealed in opaque brown envelopes
Blinding (performance bias and detection bias) change in cough frequency	High risk	The syringes used for all the 3 treatment groups were opaque and placed in a brown paper bag to conceal the treatments from the investigators. The 'no treatment' group was not blinded to their treatment but the honey and dextromethorphan arms were blinded
Blinding (performance bias and detection bias) the effect of the cough on sleep of the child	High risk	Though all participants were given syringes in brown paper bags the 'no treatment' group had empty syringes, which could influence the assessment of the outcome
Blinding (performance bias and detection bias) the effect of cough on sleep of parents	High risk	The 'no treatment' group were not blinded to the intervention they received
Selective reporting (reporting bias)	Low risk	All outcomes were adequately reported
Other bias	Unclear risk	It is unclear whether any of the 'no treatment' group revealed to any of the assessors during phone conversations that they were given 'no treatment'. Participants lost to follow‐up or withdrawn were not included in the final analysis
Follow‐up	Low risk	2 participants from the 'no treatment' group were lost to follow‐up; 1 was withdrawn from the dextromethorphan group because the participant did not take the treatment

Shadkam 2010

Methods	RCT
Participants	160 participants (40 allocated to honey, 40 allocated to dextromethorphan, 40 allocated to diphenhydramine and 40 were in the 'no treatment' group (but who received the supportive treatment given to the others); 2 to 5 years of age with URTIs, nocturnal symptoms and illness duration of 5 days
Interventions	A single dose of natural honey from Kafi‐Abad (a village in Yazd, Iran), dextromethorphan, diphenhydramine or 'no treatment' (all treatment arms were advised to take supportive treatment with saline nose drops, water vapour, cleaning of a blocked nose and use of acetaminophen for fever, if necessary)
Outcomes	Cough frequency, cough severity, cough impact on sleep quality for children and parents
Notes	160 participants were randomised into the 4 groups but only 139 were finally analysed
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomisation was by random numbers table
Allocation concealment (selection bias)	Unclear risk	It was not clear whether treatment allocation was concealed
Blinding (performance bias and detection bias) change in cough frequency	High risk	Both the investigators and caregivers were not blinded to the treatment given, which could greatly influence the assessment of outcome
Blinding (performance bias and detection bias) the effect of the cough on sleep of the child	High risk	Both the investigators and caregivers were not blinded to the treatment given, which could greatly influence the assessment of outcome
Blinding (performance bias and detection bias) the effect of cough on sleep of parents	High risk	Investigators and caregivers were not blinded to the treatment given, which could greatly influence the assessment of outcome
Selective reporting (reporting bias)	Low risk	All outcomes were adequately reported
Other bias	Unclear risk	Some of the questions put to mothers were answered by the paediatrician because the questions were ambiguous, which could also be an influence on the assessment of outcomes. Since mothers were filling in the questionnaire in the presence of the physician, this could also be a source of influence on the assessment of outcomes. No ITT analysis. Participants that were withdrawn or lost to follow‐up were also not included in the final analysis, which could also have made a difference in the effect of the interventions
Follow‐up	Low risk	7 participants from the honey group, 4 from the dextromethorphan group, 6 from the diphenhydramine group and 4 from the control group were either lost to follow‐up or withdrawn for violating the protocol

ITT: intention‐to‐treat
RCT: randomised controlled trial
URTI: upper respiratory tract infection

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos
estudios a la espera de clasificación
estudios en curso

Study	Reason for exclusion
Ahmed 2013	This is a feasibility study of honey for the treatment of cough in children. It is not a clinical trial
Gilbert 2008	This is a non‐Cochrane review on the included study selected from www.inforpoem.com by the study authors
Sopo 2014	The participants were randomised into "honey and milk" versus dextromethorphan and "honey and milk" versus levodropropizine
Warren 2007	This study is a non‐Cochrane review on the included study Paul 2007

Characteristics of studies awaiting assessment [ordered by year of study]

Ir a:

estudios incluidos
estudios excluidos
estudios en curso

NCT01356693

Methods	RCT
Participants	Patients aged 2 to 15 years with acute irritative cough
Interventions	Bromelin versus placebo
Outcomes	Symtopmatic relieve of cough
Notes	Cough less than 24 hours

IRCT201110247882N1

Methods	RCT
Participants	2‐5 years old with viral acute respiratory infection
Interventions	Honey versus diphenhydramine
Outcomes	Cough severity and frequency
Notes	Comparison study of honey versus diphenhydramine effect on cough alleviation in 2‐5 years old children with viral upper respiratory tract infection

RCT: randomised controlled trial

Characteristics of ongoing studies [author‐defined order]

Ir a:

estudios incluidos
estudios excluidos
estudios a la espera de clasificación

IRCT2014090819037N1

Trial name or title	Comparison of the effect of two kinds of Iranian honey and diphenhydramine on nocturnal cough and sleep quality in coughing children and their parents
Methods	Randomised, double‐blind
Participants	2‐5 years
Interventions	Honey versus diphenhydramine
Outcomes	Cough frequency and severity
Starting date	23 September, 2010
Contact information	Dr. Mahshid Ahmadi Gamero building, Soltan tooye st, Velayat st, Saade Salman Sq 4818914799 Sari, Islamic Republic Of Iran
Notes

Data and analyses

Open in table viewer

Comparison 1. Pre‐ and postintervention comparison

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cough frequency (mean improvement) Show forest plot	3		Mean Difference (Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.1 Comparison 1 Pre‐ and postintervention comparison, Outcome 1 Cough frequency (mean improvement).
1.1 Honey	3	300	Mean Difference (Fixed, 95% CI)	‐1.97 [‐2.68, ‐1.25]
1.2 Dextromethorphan	2	74	Mean Difference (Fixed, 95% CI)	‐1.49 [‐2.09, ‐0.88]
1.3 Diphenhydramine	1	40	Mean Difference (Fixed, 95% CI)	‐1.73 [‐2.72, ‐0.74]
1.4 Placebo (silan dates extract)	1	75	Mean Difference (Fixed, 95% CI)	‐1.0 [‐1.82, ‐0.18]
1.5 No treatment	2	79	Mean Difference (Fixed, 95% CI)	‐0.98 [‐1.38, ‐0.59]
1.6 Buckwheat honey	1	35	Mean Difference (Fixed, 95% CI)	‐1.89 [‐2.96, ‐0.81]
1.7 Natural honey from Kafi‐Abad (Iran)	1	40	Mean Difference (Fixed, 95% CI)	‐2.16 [‐3.40, ‐0.92]
1.8 Eucalyptus honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.77 [‐3.22, ‐0.32]
1.9 Labiatae honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.82 [‐3.30, ‐0.34]
1.10 Citrus honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.95 [‐3.55, ‐0.35]
2 Severity of cough (mean improvement) Show forest plot	3		Mean Difference (Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.2 Comparison 1 Pre‐ and postintervention comparison, Outcome 2 Severity of cough (mean improvement).
2.1 Honey	3	300	Mean Difference (Fixed, 95% CI)	‐1.97 [‐2.70, ‐1.24]
2.2 Dextromethorphan	2	74	Mean Difference (Fixed, 95% CI)	‐1.52 [‐2.24, ‐0.80]
2.3 Diphenhydramine	1	40	Mean Difference (Fixed, 95% CI)	‐1.83 [‐2.88, ‐0.78]
2.4 No treatment	2	79	Mean Difference (Fixed, 95% CI)	‐1.13 [‐1.54, ‐0.72]
2.5 Placebo (silan date extract)	1	75	Mean Difference (Fixed, 95% CI)	‐0.99 [‐1.81, ‐0.17]
2.6 Buckwheat honey	1	35	Mean Difference (Fixed, 95% CI)	‐1.80 [‐2.88, ‐0.72]
2.7 Natural honey from Kafi‐Abad(Iran)	1	40	Mean Difference (Fixed, 95% CI)	‐2.33 [‐3.67, ‐0.99]
2.8 Eucalyptus honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.78 [‐2.82, ‐0.74]
2.9 Labiatae honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.94 [‐3.07, ‐0.81]
2.10 Citrus honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.77 [‐2.74, ‐0.80]
3 Bothersome cough (mean improvement) reduction Show forest plot	2		Mean Difference (Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.3 Comparison 1 Pre‐ and postintervention comparison, Outcome 3 Bothersome cough (mean improvement) reduction.
3.1 Honey	2	260	Mean Difference (Fixed, 95% CI)	‐2.18 [‐3.24, ‐1.13]
3.2 Dextromethorphan	1	34	Mean Difference (Fixed, 95% CI)	‐1.94 [‐3.05, ‐0.83]
3.3 No treatment	1	39	Mean Difference (Fixed, 95% CI)	‐1.30 [‐2.07, ‐0.53]
3.4 Placebo	1	75	Mean Difference (Fixed, 95% CI)	‐1.25 [‐2.39, ‐0.11]
3.5 Buckwheat honey	1	35	Mean Difference (Fixed, 95% CI)	‐2.23 [‐3.50, ‐0.96]
3.6 Eucalyptus honey	1	75	Mean Difference (Fixed, 95% CI)	‐2.0 [‐3.82, ‐0.18]
3.7 Labiatae honey	1	75	Mean Difference (Fixed, 95% CI)	‐2.07 [‐4.03, ‐0.11]
3.8 Citrus honey	1	75	Mean Difference (Fixed, 95% CI)	‐2.16 [‐4.20, ‐0.12]
4 Children's sleep (cough impact on children's sleep score) Show forest plot	3		Mean Difference (Random, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.4 Comparison 1 Pre‐ and postintervention comparison, Outcome 4 Children's sleep (cough impact on children's sleep score).
4.1 Honey	3	300	Mean Difference (Random, 95% CI)	‐2.27 [‐3.13, ‐1.41]
4.2 Dextromethorphan	2	74	Mean Difference (Random, 95% CI)	‐1.75 [‐2.46, ‐1.04]
4.3 Diphenhydramine	1	40	Mean Difference (Random, 95% CI)	‐1.64 [‐2.58, ‐0.70]
4.4 No treatment	2	79	Mean Difference (Random, 95% CI)	‐1.28 [‐1.81, ‐0.76]
4.5 Placebo	1	75	Mean Difference (Random, 95% CI)	‐1.21 [‐2.46, 0.04]
5 Parents' sleep (cough impact on parents' sleep score) Show forest plot	3		Mean Difference (Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.5 Comparison 1 Pre‐ and postintervention comparison, Outcome 5 Parents' sleep (cough impact on parents' sleep score).
5.1 Honey	3	300	Mean Difference (Fixed, 95% CI)	‐2.30 [‐3.18, ‐1.43]
5.2 Dextromethorphan	2	74	Mean Difference (Fixed, 95% CI)	‐1.97 [‐2.77, ‐1.17]
5.3 Diphenhydramine	1	40	Mean Difference (Fixed, 95% CI)	‐1.89 [‐2.97, ‐0.81]
5.4 No treatment	2	79	Mean Difference (Fixed, 95% CI)	‐1.46 [‐2.06, ‐0.87]
5.5 Placebo	1	75	Mean Difference (Fixed, 95% CI)	‐1.28 [‐2.64, 0.08]
6 Combined improvement Show forest plot	2		Mean Difference (Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.6 Comparison 1 Pre‐ and postintervention comparison, Outcome 6 Combined improvement.
6.1 Honey	2	260	Mean Difference (Fixed, 95% CI)	‐9.11 [‐11.31, ‐6.90]
6.2 Dextromethorphan	1	34	Mean Difference (Fixed, 95% CI)	‐8.39 [‐10.95, ‐5.84]
6.3 No treatment	1	39	Mean Difference (Fixed, 95% CI)	‐6.41 [‐8.82, ‐3.99]
6.4 Placebo	1	75	Mean Difference (Fixed, 95% CI)	‐5.82 [‐10.76, ‐0.88]

Open in table viewer

Comparison 2. Pair‐wise comparison

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Honey versus dextromethorphan Show forest plot	2		Mean Difference (Random, 95% CI)	Subtotals only
Open in figure viewer Analysis 2.1 Comparison 2 Pair‐wise comparison, Outcome 1 Honey versus dextromethorphan.
1.1 Frequency of cough (mean improvement)	2	149	Mean Difference (Random, 95% CI)	‐0.07 [‐1.07, 0.94]
1.2 Severity of cough (mean improvement)	2	149	Mean Difference (Random, 95% CI)	‐0.13 [‐1.25, 0.99]
1.3 Bothersome cough (mean improvement)	1	69	Mean Difference (Random, 95% CI)	0.29 [‐0.56, 1.14]
1.4 Children's sleep (cough impact on children's sleep score)	2	149	Mean Difference (Random, 95% CI)	0.03 [‐1.12, 1.19]
1.5 Parents' sleep (cough impact on parents' sleep score)	2	149	Mean Difference (Random, 95% CI)	‐0.16 [‐0.84, 0.53]
1.6 Combined mean improvement	1	69	Mean Difference (Random, 95% CI)	2.32 [‐1.24, 5.88]
2 Honey versus diphenhydramine Show forest plot	1		Mean Difference (Random, 95% CI)	Subtotals only
Open in figure viewer Analysis 2.2 Comparison 2 Pair‐wise comparison, Outcome 2 Honey versus diphenhydramine.
2.1 Frequency of cough (mean improvement)	1	80	Mean Difference (Random, 95% CI)	‐0.57 [‐0.90, ‐0.24]
2.2 Severity of cough (mean improvement)	1	80	Mean Difference (Random, 95% CI)	‐0.6 [‐0.94, ‐0.26]
2.3 Children's sleep (cough impact on children's sleep score)	1	80	Mean Difference (Random, 95% CI)	‐0.55 [‐0.87, ‐0.23]
2.4 Parents' sleep (cough impact on parents' sleep score)	1	80	Mean Difference (Random, 95% CI)	‐0.48 [‐0.76, ‐0.20]
3 Honey versus 'no treatment' Show forest plot	2		Mean Difference (Random, 95% CI)	Subtotals only
Open in figure viewer Analysis 2.3 Comparison 2 Pair‐wise comparison, Outcome 3 Honey versus 'no treatment'.
3.1 Frequency of cough (mean improvement score)	2	154	Mean Difference (Random, 95% CI)	‐1.05 [‐1.48, ‐0.62]
3.2 Severity of cough (mean improvement)	2	154	Mean Difference (Random, 95% CI)	‐1.03 [‐1.59, ‐0.47]
3.3 Bothersome cough (mean improvement)	1	74	Mean Difference (Random, 95% CI)	‐0.93 [‐1.98, 0.12]
3.4 Children's sleep (cough impact on children's sleep score)	2	154	Mean Difference (Random, 95% CI)	‐1.04 [‐1.57, ‐0.51]
3.5 Parents' sleep (cough impact on parents' sleep score)	2	154	Mean Difference (Random, 95% CI)	‐0.88 [‐1.23, ‐0.52]
3.6 Combined mean improvement	1	74	Mean Difference (Random, 95% CI)	‐4.31 [‐6.77, ‐1.85]
4 Honey versus placebo (silan dates extract) Show forest plot	1		Mean Difference (Random, 95% CI)	Subtotals only
Open in figure viewer Analysis 2.4 Comparison 2 Pair‐wise comparison, Outcome 4 Honey versus placebo (silan dates extract).
4.1 Frequency of cough (mean improvement score)	1	300	Mean Difference (Random, 95% CI)	‐1.85 [‐3.36, ‐0.33]
4.2 Severity of cough (mean improvement)	1	300	Mean Difference (Random, 95% CI)	‐1.83 [‐3.32, ‐0.34]
4.3 Bothersome cough (mean improvement) reduction	1	300	Mean Difference (Random, 95% CI)	‐2.08 [‐3.97, ‐0.19]
4.4 Children's sleep (cough impact on children's sleep score)	1	300	Mean Difference (Random, 95% CI)	‐1.94 [‐3.93, 0.06]
4.5 Parents' sleep (cough impact on parents' sleep score)	1	300	Mean Difference (Random, 95% CI)	‐2.05 [‐4.24, 0.13]

Open in table viewer

Comparison 3. Adverse events

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Nervousness, insomnia, hyperactivity Show forest plot	2	149	Risk Ratio (M‐H, Fixed, 95% CI)	2.94 [0.74, 11.71]
Open in figure viewer Analysis 3.1 Comparison 3 Adverse events, Outcome 1 Nervousness, insomnia, hyperactivity.
2 Stomach ache, nausea and vomiting Show forest plot	2	149	Risk Ratio (M‐H, Fixed, 95% CI)	4.86 [0.24, 97.69]
Open in figure viewer Analysis 3.2 Comparison 3 Adverse events, Outcome 2 Stomach ache, nausea and vomiting.
3 Drowsiness Show forest plot	2	149	Risk Ratio (M‐H, Fixed, 95% CI)	2.92 [0.12, 69.20]
Open in figure viewer Analysis 3.3 Comparison 3 Adverse events, Outcome 3 Drowsiness.
4 Somnolence Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.14 [0.01, 2.68]
Open in figure viewer Analysis 3.4 Comparison 3 Adverse events, Outcome 4 Somnolence.
5 Stomach ache, nausea and vomiting Show forest plot	1	300	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.15, 11.74]
Open in figure viewer Analysis 3.5 Comparison 3 Adverse events, Outcome 5 Stomach ache, nausea and vomiting.
5.1 Honey	1	300	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.15, 11.74]

Figure 1

'Risk of bias' graph for included studies

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1 Pre‐ and postintervention comparison, Outcome 1 Cough frequency (mean improvement).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 Pre‐ and postintervention comparison, Outcome 2 Severity of cough (mean improvement).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 Pre‐ and postintervention comparison, Outcome 3 Bothersome cough (mean improvement) reduction.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 Pre‐ and postintervention comparison, Outcome 4 Children's sleep (cough impact on children's sleep score).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1 Pre‐ and postintervention comparison, Outcome 5 Parents' sleep (cough impact on parents' sleep score).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1 Pre‐ and postintervention comparison, Outcome 6 Combined improvement.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2 Pair‐wise comparison, Outcome 1 Honey versus dextromethorphan.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2 Pair‐wise comparison, Outcome 2 Honey versus diphenhydramine.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2 Pair‐wise comparison, Outcome 3 Honey versus 'no treatment'.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

Comparison 2 Pair‐wise comparison, Outcome 4 Honey versus placebo (silan dates extract).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3 Adverse events, Outcome 1 Nervousness, insomnia, hyperactivity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3 Adverse events, Outcome 2 Stomach ache, nausea and vomiting.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.3

Comparison 3 Adverse events, Outcome 3 Drowsiness.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.4

Comparison 3 Adverse events, Outcome 4 Somnolence.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.5

Comparison 3 Adverse events, Outcome 5 Stomach ache, nausea and vomiting.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings for the main comparison. Honey versus dextromethorphan for acute cough in children

Honey versus dextromethorphan
Patient or population: children with acute cough Settings: ambulatory Intervention: honey Comparison: dextromethorphan
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Dextromethorphan	Honey
Cough frequency (mean improvement in symptom score) 7‐point Likert scale. Scale from: 0 to 6 Follow‐up: mean 1 day	The mean cough frequency (mean improvement in symptom score) in the control groups was 2.1	The mean cough frequency (mean improvement in symptom score) in the intervention groups was 0.14 lower (0.33 lower to 0.06 higher)		137 (2 studies)	⊕⊕⊕⊝ moderate¹
Cough severity (mean improvement in symptom score) 7‐point Likert scale. Scale from: 0 to 6 Follow‐up: mean 1 day	The mean cough severity (mean improvement in symptom score) in the control groups was 1.5	The mean cough severity (mean improvement in symptom score) in the intervention groups was 0.61 higher (0.27 to 0.94 higher)		137 (2 studies)	⊕⊕⊕⊝ moderate¹
Child's sleep (mean improvement score) 7‐point Likert scale. Scale from: 0 to 6 Follow‐up: mean 1 day	The mean child's sleep (mean improvement score) in the control groups was 1.26	The mean child's sleep (mean improvement score) in the intervention groups was 0.66 higher (0.53 to 0.8 higher)		137 (2 studies)	⊕⊕⊕⊝ moderate¹
Parents' sleep (mean improvement score) 7‐point Likert scale. Scale from: 0 to 6 Follow‐up: mean 1 day	The mean parents' sleep (mean improvement score) in the control groups was 1.97	The mean parents' sleep (mean improvement score) in the intervention groups was 0.36 higher (0.23 to 0.49 higher)		137 (2 studies)	⊕⊕⊕⊝ moderate¹
Improvement in quality of life: combined effect (mean improvement in symptom score) 7‐poit Likert scale. Scale from: 0 to 6 Follow‐up: mean 1 day	The mean improvement in quality of life: combined effect (mean improvement in symptom score) in the control groups was 8.39	The mean improvement in quality of life: combined effect (mean improvement in symptom score) in the intervention groups was 2.31 higher (1.7 to 2.92 higher)		68 (1 study)	⊕⊕⊕⊕ high
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹It was unclear if Shadkam 2010 had allocation concealment and there was no blinding in the study, which could increase the risk of bias in the study outcomes, although there was allocation concealment and partial double‐blinding in Paul 2007.

Summary of findings for the main comparison. Honey versus dextromethorphan for acute cough in children

Ir a la tabla de la revisión

Summary of findings 2. Honey compared to diphenhydramine for acute cough in children

Honey compared to diphenhydramine for acute cough in children
Patient or population: children with acute cough Settings: ambulatory Intervention: honey Comparison: diphenhydramine
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Diphenhydramine	Honey
Frequency of cough (mean improvement score) 7‐point Likert scale Scale from: 0 to 6 Follow‐up: mean 1 day	The mean frequency of cough (mean improvement) in the control groups was ‐1.73	The mean frequency of cough (mean improvement) in the intervention groups was 0.57 lower (0.9 to 0.24 lower)		80 (1 study)	⊕⊕⊝⊝ low
Severity of cough (mean improvement score) 7‐point Likert scale Scale from: 0 to 6 Follow‐up: mean 1 day	The mean severity of cough (mean improvement) in the control groups was ‐1.83	The mean severity of cough (mean improvement) in the intervention groups was 0.6 lower (0.94 to 0.26 lower)		80 (1 study)	⊕⊕⊝⊝ low¹
Children's sleep (cough impact on children's sleep score) 7‐point Likert scale Scale from: 0 to 6 Follow‐up: mean 1 day	The mean children's sleep quality (cough impact on children's sleep score) in the control groups was ‐1.64	The mean children's sleep quality (cough impact on children's sleep score) in the intervention groups was 0.55 lower (0.87 to 0.23 lower)		80 (1 study)	⊕⊕⊝⊝ low
Parents' sleep (cough impact on parents' sleep score) 7‐point Likert scale Scale from: 0 to 6 Follow‐up: mean 1 day	The mean parents' sleep quality (cough impact on parents' sleep score) in the control groups was ‐1.89	The mean parents' sleep quality (cough impact on parents' sleep score) in the intervention groups was 0.48 lower (0.76 to 0.2 lower)		80 (1 study)	⊕⊕⊝⊝ low
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95%) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
¹None of the treatment arms were blinded by Shadkam 2010 and allocation concealment was unclear. It was the same for the other outcomes.

Summary of findings 2. Honey compared to diphenhydramine for acute cough in children

Ir a la tabla de la revisión

Summary of findings 3. Honey compared to 'no treatment' for acute cough in children

Honey compared to 'no treatment' for acute cough in children
Patient or population: children with acute cough Settings: ambulatory Intervention: honey Comparison: 'no treatment'
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	'No treatment'	Honey
Frequency of cough (mean improvement score) 7‐point Likert scale Scale from: 0 to 6 Follow‐up: mean 1 day	The mean frequency of cough (mean improvement) in the control groups was ‐0.97	The mean frequency of cough (mean improvement score) in the intervention groups was 1.07 lower (1.53 to 0.6 lower)		154 (2 studies)	⊕⊕⊕⊝ moderate¹
Severity of cough (mean improvement score) 7‐point Likert scale Scale from: 0 to 6 Follow‐up: mean 1 day	The mean severity of cough (mean improvement) in the control groups was ‐1.13	The mean severity of cough (mean improvement) in the intervention groups was 0.97 lower (1.47 to 0.46 lower)		154 (2 studies)	⊕⊕⊕⊝ moderate²
Bothersome cough (mean improvement score) 7‐point Likert scale Scale from: 0 to 6 Follow‐up: mean 1 day	The mean bothersome cough (mean improvement) in the control groups was ‐0.93	The mean bothersome cough (mean improvement) in the intervention groups was 0.93 lower (1.77 to 0.09 lower)		74 (1 study)	⊕⊕⊕⊝ moderate²
Childrens' sleep (cough impact on children's sleep score) 7‐point Likert scale Scale from: 0 to 6 Follow‐up: mean 1 day	The mean children's sleep quality (cough impact on children's sleep quality score) in the control groups was ‐1.37	The mean children's sleep quality (cough impact on children's sleep quality score) in the intervention groups was 1.02 lower (1.52 to 0.52 lower)		154 (2 studies)	⊕⊕⊕⊝ moderate²
Parents' sleep (cough impact on parents' sleep score) 7‐point Likert scale Scale from: 0 to 6 Follow‐up: mean 1 day	The mean parents' sleep quality (cough impact on parents' sleep score) in the control groups was ‐1.48	The mean parents' sleep quality (cough impact on parents' sleep score) in the intervention groups was 0.93 lower (1.41 to 0.46 lower)		154 (2 studies)	⊕⊕⊕⊝ moderate²
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
¹The 'no treatment' group were not blinded in either of the studies; allocation concealment was unclear in the Shadkam 2010 study. ²No explanation was provided.

Summary of findings 3. Honey compared to 'no treatment' for acute cough in children

Ir a la tabla de la revisión

Summary of findings 4. Honey compared to placebo for acute cough in children

Honey compared to placebo for acute cough in children
Patient or population: children with acute cough Settings: ambulatory Intervention: honey Comparison: placebo
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Placebo	Honey
Frequency of cough (mean improvement score) 7‐point Likert scale Scale from: 0 to 6 Follow‐up: mean 1 day	The mean frequency of cough (mean improvement score) in the control groups was ‐1.00	The mean frequency of cough (mean improvement score) in the intervention groups was 1.85 lower (3.36 to 0.33 lower)		300 (1 study)	⊕⊕⊕⊕ high	We downgraded quality of evidence to moderate because only 1 high quality RCT compared honey to placebo
Severity of cough (mean improvement score) 7‐point Likert scale Scale from: 0 to 6 Follow‐up: mean 1 day	The mean severity of cough (mean improvement score) in the control groups was ‐0.99	The mean severity of cough (mean improvement score) in the intervention groups was 1.83 lower (3.32 to 0.34 lower)		300 (1 study)	⊕⊕⊕⊕ high	Downgraded (same reason as above)
Bothersome cough 7‐point Likert scale. Scale from: 0 to 6 Follow‐up: mean 1 day	The mean bothersome cough in the control groups was ‐1.25	The mean bothersome cough in the intervention groups was 2.08 lower (3.97 to 0.19 lower)		300 (1 study)	⊕⊕⊕⊕ high	Downgraded (same reason as above)
Child's sleep (cough impact on child's sleep 7‐point Likert scale. Scale from: 0 to 6 Follow‐up: mean 1 day	The mean child's sleep (cough impact on child's sleep in the control groups was ‐1.21	The mean child's sleep (cough impact on child's sleep in the intervention groups was 1.94 lower (3.93 lower to 0.06 higher)		300 (1 study)	⊕⊕⊕⊕ high	Downgraded (same reason as above)
Parents' sleep (cough impact on parents' sleep score) 7‐point Likert scale. Scale from: 0 to 6 Follow‐up: mean 1 day	The mean parents' sleep (cough impact on parents' sleep score) in the control groups was ‐1.28	The mean parents' sleep (cough impact on parents' sleep score) in the intervention groups was 2.05 lower (4.24 lower to 0.13 higher)		300 (1 study)	⊕⊕⊕⊕ high	Downgraded (same reason as above)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

Summary of findings 4. Honey compared to placebo for acute cough in children

Ir a la tabla de la revisión

Summary of findings 5. Adverse events

Adverse events
Patient or population: children with acute cough Settings: ambulatory Intervention: honey
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Honey
Nervousness, insomnia, hyperactivity (honey versus dextromethorphan) Fixed‐effect Mantel‐Haenszel (M‐H) risk ratio Follow‐up: mean 1 day	Study population		RR 2.94 (0.74 to 11.71)	149 (2 studies)	⊕⊕⊕⊝ moderate
	27 per 1000	79 per 1000 (20 to 316)
	Moderate
	29 per 1000	85 per 1000 (21 to 340)
Stomach ache, nausea and vomiting (honey versus dextromethorphan) Fixed‐effect Mantel‐Haenszel (M‐H) risk ratio Follow‐up: mean 1 day	Study population		RR 4.86 (0.24 to 97.69)	149 (2 studies)	⊕⊕⊕⊝ moderate¹
	0 per 1000	0 per 1000 (0 to 0)
	Moderate
	0 per 1000	0 per 1000 (0 to 0)
Drowsiness (honey versus dextromethorphan) Fixed‐effect Mantel‐Haenszel (M‐H) risk ratio Follow‐up: mean 1 day	Study population		RR 2.92 (0.12 to 69.2)	149 (2 studies)	⊕⊕⊕⊝ moderate¹
	0 per 1000	0 per 1000 (0 to 0)
	Moderate
	0 per 1000	0 per 1000 (0 to 0)
Somnolence (honey versus diphenhydramine) Fixed‐effect Mantel‐Haenszel (M‐H) risk ratio Follow‐up: mean 1 day	Study population		RR 0.14 (0.01 to 2.68)	80 (1 study)	⊕⊕⊕⊝ moderate²
	75 per 1000	10 per 1000 (1 to 201)
	Moderate
	75 per 1000	10 per 1000 (1 to 201)
Stomach ache, nausea and vomiting (honey versus placebo) Fixed effect Mantel‐Haenszel (M‐H) risk ratio Follow‐up: mean 1 day	Study population		RR 1.34 (0.15 to 12.17)	300 (1 study)	⊕⊕⊕⊕ high	We downgraded the evidence because only 1 high quality RCT compared honey versus placebo
	13 per 1000	18 per 1000 (2 to 162)
	Moderate

The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹No explanation was provided. ²None of the treatment arms were blinded in Shadkam 2010.

Summary of findings 5. Adverse events

Ir a la tabla de la revisión

Comparison 1. Pre‐ and postintervention comparison

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cough frequency (mean improvement) Show forest plot	3		Mean Difference (Fixed, 95% CI)	Subtotals only

1.1 Honey	3	300	Mean Difference (Fixed, 95% CI)	‐1.97 [‐2.68, ‐1.25]
1.2 Dextromethorphan	2	74	Mean Difference (Fixed, 95% CI)	‐1.49 [‐2.09, ‐0.88]
1.3 Diphenhydramine	1	40	Mean Difference (Fixed, 95% CI)	‐1.73 [‐2.72, ‐0.74]
1.4 Placebo (silan dates extract)	1	75	Mean Difference (Fixed, 95% CI)	‐1.0 [‐1.82, ‐0.18]
1.5 No treatment	2	79	Mean Difference (Fixed, 95% CI)	‐0.98 [‐1.38, ‐0.59]
1.6 Buckwheat honey	1	35	Mean Difference (Fixed, 95% CI)	‐1.89 [‐2.96, ‐0.81]
1.7 Natural honey from Kafi‐Abad (Iran)	1	40	Mean Difference (Fixed, 95% CI)	‐2.16 [‐3.40, ‐0.92]
1.8 Eucalyptus honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.77 [‐3.22, ‐0.32]
1.9 Labiatae honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.82 [‐3.30, ‐0.34]
1.10 Citrus honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.95 [‐3.55, ‐0.35]
2 Severity of cough (mean improvement) Show forest plot	3		Mean Difference (Fixed, 95% CI)	Subtotals only

2.1 Honey	3	300	Mean Difference (Fixed, 95% CI)	‐1.97 [‐2.70, ‐1.24]
2.2 Dextromethorphan	2	74	Mean Difference (Fixed, 95% CI)	‐1.52 [‐2.24, ‐0.80]
2.3 Diphenhydramine	1	40	Mean Difference (Fixed, 95% CI)	‐1.83 [‐2.88, ‐0.78]
2.4 No treatment	2	79	Mean Difference (Fixed, 95% CI)	‐1.13 [‐1.54, ‐0.72]
2.5 Placebo (silan date extract)	1	75	Mean Difference (Fixed, 95% CI)	‐0.99 [‐1.81, ‐0.17]
2.6 Buckwheat honey	1	35	Mean Difference (Fixed, 95% CI)	‐1.80 [‐2.88, ‐0.72]
2.7 Natural honey from Kafi‐Abad(Iran)	1	40	Mean Difference (Fixed, 95% CI)	‐2.33 [‐3.67, ‐0.99]
2.8 Eucalyptus honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.78 [‐2.82, ‐0.74]
2.9 Labiatae honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.94 [‐3.07, ‐0.81]
2.10 Citrus honey	1	75	Mean Difference (Fixed, 95% CI)	‐1.77 [‐2.74, ‐0.80]
3 Bothersome cough (mean improvement) reduction Show forest plot	2		Mean Difference (Fixed, 95% CI)	Subtotals only

3.1 Honey	2	260	Mean Difference (Fixed, 95% CI)	‐2.18 [‐3.24, ‐1.13]
3.2 Dextromethorphan	1	34	Mean Difference (Fixed, 95% CI)	‐1.94 [‐3.05, ‐0.83]
3.3 No treatment	1	39	Mean Difference (Fixed, 95% CI)	‐1.30 [‐2.07, ‐0.53]
3.4 Placebo	1	75	Mean Difference (Fixed, 95% CI)	‐1.25 [‐2.39, ‐0.11]
3.5 Buckwheat honey	1	35	Mean Difference (Fixed, 95% CI)	‐2.23 [‐3.50, ‐0.96]
3.6 Eucalyptus honey	1	75	Mean Difference (Fixed, 95% CI)	‐2.0 [‐3.82, ‐0.18]
3.7 Labiatae honey	1	75	Mean Difference (Fixed, 95% CI)	‐2.07 [‐4.03, ‐0.11]
3.8 Citrus honey	1	75	Mean Difference (Fixed, 95% CI)	‐2.16 [‐4.20, ‐0.12]
4 Children's sleep (cough impact on children's sleep score) Show forest plot	3		Mean Difference (Random, 95% CI)	Subtotals only

4.1 Honey	3	300	Mean Difference (Random, 95% CI)	‐2.27 [‐3.13, ‐1.41]
4.2 Dextromethorphan	2	74	Mean Difference (Random, 95% CI)	‐1.75 [‐2.46, ‐1.04]
4.3 Diphenhydramine	1	40	Mean Difference (Random, 95% CI)	‐1.64 [‐2.58, ‐0.70]
4.4 No treatment	2	79	Mean Difference (Random, 95% CI)	‐1.28 [‐1.81, ‐0.76]
4.5 Placebo	1	75	Mean Difference (Random, 95% CI)	‐1.21 [‐2.46, 0.04]
5 Parents' sleep (cough impact on parents' sleep score) Show forest plot	3		Mean Difference (Fixed, 95% CI)	Subtotals only

5.1 Honey	3	300	Mean Difference (Fixed, 95% CI)	‐2.30 [‐3.18, ‐1.43]
5.2 Dextromethorphan	2	74	Mean Difference (Fixed, 95% CI)	‐1.97 [‐2.77, ‐1.17]
5.3 Diphenhydramine	1	40	Mean Difference (Fixed, 95% CI)	‐1.89 [‐2.97, ‐0.81]
5.4 No treatment	2	79	Mean Difference (Fixed, 95% CI)	‐1.46 [‐2.06, ‐0.87]
5.5 Placebo	1	75	Mean Difference (Fixed, 95% CI)	‐1.28 [‐2.64, 0.08]
6 Combined improvement Show forest plot	2		Mean Difference (Fixed, 95% CI)	Subtotals only

6.1 Honey	2	260	Mean Difference (Fixed, 95% CI)	‐9.11 [‐11.31, ‐6.90]
6.2 Dextromethorphan	1	34	Mean Difference (Fixed, 95% CI)	‐8.39 [‐10.95, ‐5.84]
6.3 No treatment	1	39	Mean Difference (Fixed, 95% CI)	‐6.41 [‐8.82, ‐3.99]
6.4 Placebo	1	75	Mean Difference (Fixed, 95% CI)	‐5.82 [‐10.76, ‐0.88]

Comparison 1. Pre‐ and postintervention comparison

Ir a la tabla de la revisión

Comparison 2. Pair‐wise comparison

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Honey versus dextromethorphan Show forest plot	2		Mean Difference (Random, 95% CI)	Subtotals only

1.1 Frequency of cough (mean improvement)	2	149	Mean Difference (Random, 95% CI)	‐0.07 [‐1.07, 0.94]
1.2 Severity of cough (mean improvement)	2	149	Mean Difference (Random, 95% CI)	‐0.13 [‐1.25, 0.99]
1.3 Bothersome cough (mean improvement)	1	69	Mean Difference (Random, 95% CI)	0.29 [‐0.56, 1.14]
1.4 Children's sleep (cough impact on children's sleep score)	2	149	Mean Difference (Random, 95% CI)	0.03 [‐1.12, 1.19]
1.5 Parents' sleep (cough impact on parents' sleep score)	2	149	Mean Difference (Random, 95% CI)	‐0.16 [‐0.84, 0.53]
1.6 Combined mean improvement	1	69	Mean Difference (Random, 95% CI)	2.32 [‐1.24, 5.88]
2 Honey versus diphenhydramine Show forest plot	1		Mean Difference (Random, 95% CI)	Subtotals only

2.1 Frequency of cough (mean improvement)	1	80	Mean Difference (Random, 95% CI)	‐0.57 [‐0.90, ‐0.24]
2.2 Severity of cough (mean improvement)	1	80	Mean Difference (Random, 95% CI)	‐0.6 [‐0.94, ‐0.26]
2.3 Children's sleep (cough impact on children's sleep score)	1	80	Mean Difference (Random, 95% CI)	‐0.55 [‐0.87, ‐0.23]
2.4 Parents' sleep (cough impact on parents' sleep score)	1	80	Mean Difference (Random, 95% CI)	‐0.48 [‐0.76, ‐0.20]
3 Honey versus 'no treatment' Show forest plot	2		Mean Difference (Random, 95% CI)	Subtotals only

3.1 Frequency of cough (mean improvement score)	2	154	Mean Difference (Random, 95% CI)	‐1.05 [‐1.48, ‐0.62]
3.2 Severity of cough (mean improvement)	2	154	Mean Difference (Random, 95% CI)	‐1.03 [‐1.59, ‐0.47]
3.3 Bothersome cough (mean improvement)	1	74	Mean Difference (Random, 95% CI)	‐0.93 [‐1.98, 0.12]
3.4 Children's sleep (cough impact on children's sleep score)	2	154	Mean Difference (Random, 95% CI)	‐1.04 [‐1.57, ‐0.51]
3.5 Parents' sleep (cough impact on parents' sleep score)	2	154	Mean Difference (Random, 95% CI)	‐0.88 [‐1.23, ‐0.52]
3.6 Combined mean improvement	1	74	Mean Difference (Random, 95% CI)	‐4.31 [‐6.77, ‐1.85]
4 Honey versus placebo (silan dates extract) Show forest plot	1		Mean Difference (Random, 95% CI)	Subtotals only

4.1 Frequency of cough (mean improvement score)	1	300	Mean Difference (Random, 95% CI)	‐1.85 [‐3.36, ‐0.33]
4.2 Severity of cough (mean improvement)	1	300	Mean Difference (Random, 95% CI)	‐1.83 [‐3.32, ‐0.34]
4.3 Bothersome cough (mean improvement) reduction	1	300	Mean Difference (Random, 95% CI)	‐2.08 [‐3.97, ‐0.19]
4.4 Children's sleep (cough impact on children's sleep score)	1	300	Mean Difference (Random, 95% CI)	‐1.94 [‐3.93, 0.06]
4.5 Parents' sleep (cough impact on parents' sleep score)	1	300	Mean Difference (Random, 95% CI)	‐2.05 [‐4.24, 0.13]

Comparison 2. Pair‐wise comparison

Ir a la tabla de la revisión

Comparison 3. Adverse events

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Nervousness, insomnia, hyperactivity Show forest plot	2	149	Risk Ratio (M‐H, Fixed, 95% CI)	2.94 [0.74, 11.71]

2 Stomach ache, nausea and vomiting Show forest plot	2	149	Risk Ratio (M‐H, Fixed, 95% CI)	4.86 [0.24, 97.69]

3 Drowsiness Show forest plot	2	149	Risk Ratio (M‐H, Fixed, 95% CI)	2.92 [0.12, 69.20]

4 Somnolence Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.14 [0.01, 2.68]

5 Stomach ache, nausea and vomiting Show forest plot	1	300	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.15, 11.74]

5.1 Honey	1	300	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.15, 11.74]

Comparison 3. Adverse events

Ir a la tabla de la revisión

	Idioma de la Revisión Cochrane Escoja su idioma de preferencia para las revisiones Cochrane y otros contenidos. Las secciones sin una traducción aparecerán en inglés.

	Idioma de la web Escoja su idioma de preferencia para la web de la Biblioteca Cochrane.

Idioma de la Revisión Cochrane

Idioma de la web

Referencias

References to studies included in this review

Cohen 2012 {published data only}

Paul 2007 {published and unpublished data}

Shadkam 2010 {published data only}

References to studies excluded from this review

Ahmed 2013 {published data only}

Gilbert 2008 {published data only}

Sopo 2014 {published data only}

Warren 2007 {published data only}

References to studies awaiting assessment

IRCT201110247882N1 {published data only}

NCT01356693 {published data only}

References to ongoing studies

IRCT2014090819037N1 {published data only}

Additional references

Abramson 1999 [Computer program]

Adeleye 2003

Agbaje 2006

Banderali 1995

Braman 2006

Butler 2005

CDC 2007

Chang 2005

Chang 2014

Cherry 2003

Dicpinigaitis 2009

El‐Gindy 2005

Fisher 1922

Freestone 1997

French 1998

French 2002

Garedew 2004

Golob 2005

Gonzales 2000

Greaves 1997

Gunn 2001

Havsteen 2002

Hay 2003

Hermosin 2003

Hernández 2005

Higgins 2011

Kelly 2004

Kurth 1978

Kusel 2007

Küplülü 2006

Landau 2006

Lefebvre 2011

Likert 1932

Lusby 2005

Meyer 1996

Molan 2006

Morice 1998

Mullai 2007

Nagai 2006

Nanda 2003

Nevas 2002

PAGB 2000

RevMan 2014 [Computer program]

Sanz 2004

Smith 1993

Smith 2012

Suárez‐Luque 2002

Tonks 2003

Tuzen 2007

Yao 2003

Zeina 1996

References to other published versions of this review

Oduwole 2008

Oduwole 2010

Oduwole 2012

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Characteristics of studies awaiting assessment [ordered by year of study]

Characteristics of ongoing studies [author‐defined order]

Data and analyses

Copiar o descargar referencia