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Epinefrina para la bronquiolitis
Lisa Hartling, Liza M Bialy, Ben Vandermeer, Lisa Tjosvold, David W Johnson, Amy C Plint, Terry P Klassen, Hema Patel, Ricardo M Fernandes | 15 junio 2011

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Temas

'Risk of bias' graph for included studies
Figuras y tablas -
Figure 1

'Risk of bias' graph for included studies

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

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

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Comparison 1 Pre‐ and postintervention comparison, Outcome 1 Cough frequency (mean improvement).
Figuras y tablas -
Analysis 1.1

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

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Comparison 1 Pre‐ and postintervention comparison, Outcome 2 Severity of cough (mean improvement).
Figuras y tablas -
Analysis 1.2

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

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Comparison 1 Pre‐ and postintervention comparison, Outcome 3 Bothersome cough (mean improvement) reduction.
Figuras y tablas -
Analysis 1.3

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

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Comparison 1 Pre‐ and postintervention comparison, Outcome 4 Children's sleep (cough impact on children's sleep score).
Figuras y tablas -
Analysis 1.4

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

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Comparison 1 Pre‐ and postintervention comparison, Outcome 5 Parents' sleep (cough impact on parents' sleep score).
Figuras y tablas -
Analysis 1.5

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

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Comparison 1 Pre‐ and postintervention comparison, Outcome 6 Combined improvement.
Figuras y tablas -
Analysis 1.6

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

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Comparison 2 Pair‐wise comparison, Outcome 1 Honey versus dextromethorphan.
Figuras y tablas -
Analysis 2.1

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

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Comparison 2 Pair‐wise comparison, Outcome 2 Honey versus diphenhydramine.
Figuras y tablas -
Analysis 2.2

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

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Comparison 2 Pair‐wise comparison, Outcome 3 Honey versus 'no treatment'.
Figuras y tablas -
Analysis 2.3

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

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Comparison 2 Pair‐wise comparison, Outcome 4 Honey versus placebo (silan dates extract).
Figuras y tablas -
Analysis 2.4

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

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Comparison 3 Adverse events, Outcome 1 Nervousness, insomnia, hyperactivity.
Figuras y tablas -
Analysis 3.1

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

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Comparison 3 Adverse events, Outcome 2 Stomach ache, nausea and vomiting.
Figuras y tablas -
Analysis 3.2

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

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Comparison 3 Adverse events, Outcome 3 Drowsiness.
Figuras y tablas -
Analysis 3.3

Comparison 3 Adverse events, Outcome 3 Drowsiness.

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Comparison 3 Adverse events, Outcome 4 Somnolence.
Figuras y tablas -
Analysis 3.4

Comparison 3 Adverse events, Outcome 4 Somnolence.

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Comparison 3 Adverse events, Outcome 5 Stomach ache, nausea and vomiting.
Figuras y tablas -
Analysis 3.5

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

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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.

Figuras y tablas -
Summary of findings for the main comparison. Honey versus dextromethorphan for acute cough in children
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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.

Figuras y tablas -
Summary of findings 2. Honey compared to diphenhydramine for acute cough in children
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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.

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

Figuras y tablas -
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.

Figuras y tablas -
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]
Figuras y tablas -
Comparison 1. Pre‐ and postintervention comparison
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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]
Figuras y tablas -
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]
Figuras y tablas -
Comparison 3. Adverse events
Ir a la tabla de la revisión