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Miel para la tos aguda en niños

Appendices

Appendix 1. AMED (Ovid) search strategy

1 cough/
2 cough*.tw.
3 1 or 2
4 honey/
5 honey*.tw.
6 4 or 5
7 3 and 6

Appendix 2. CAB Abstracts (Thomson Reuters) search strategy

Topic=(cough*) AND Topic=(honey*)Timespan=2009‐2011. Databases=CAB Abstracts.

Appendix 3. Previous searches

For the 2014 update we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 10), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 2012 to October week 4, 2014), EMBASE (January 2012 to October 2014), CINAHL (January 2012 to October 2014), Web of Science (2011 to October 2014), AMED (2011 to October 2014), LILACS (2011 to October 2014) and CAB abstracts (2011 to January 2014).

Our initial 2009 search covered CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE (1950 to April Week 2, 2009), Embase (1990 to April 2009), CINAHL (1982 to April 2009), Web of Science (2000 to April 2009), AMED (1985 April 2009) and LILACS (1982 to April 2009). The search was then updated in January 2012 to cover the period April 2009 to January 2012.

Appendix 4. CENTRAL and MEDLINE (Ovid) search strategy

1 Cough/
2 cough*.tw
3 cough*.tw
4 Honey/
5 honey*.tw.
6 4 or 5
7 3 and 6

Appendix 5. Embase (Elsevier) search strategy

#7. #3 AND #6
#6. #4 OR #5
#5. honey*:ab,ti
#4. 'honey'/de
#3. #1 OR #2
#2. cough*:ab,ti
#1. 'coughing'/exp

Appendix 6. CINAHL (EBSCO) search strategy

S7 S3 and S6
S6 S4 or S5
S5 TI honey* or AB honey*
S4 (MH "Honey")
S3 S1 or S2
S2 TI cough* or AB cough*
S1 (MH "Cough")

Appendix 7. Web of Science (Clarivate Analytics) search strategy

Topic=(cough*) AND Topic=(honey*)

Appendix 8. LILACS (BIREME) search strategy

(mh:cough OR cough* OR tos OR tosse) AND (mh:honey OR honey* OR miel OR mel) AND db:("LILACS")

Study flow diagram (2018 update).
Figuras y tablas -
Figure 1

Study flow diagram (2018 update).

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

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

Comparison 1 Pair‐wise comparison, Outcome 1 Honey versus dextromethorphan.
Figuras y tablas -
Analysis 1.1

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

Comparison 1 Pair‐wise comparison, Outcome 2 Honey versus diphenhydramine.
Figuras y tablas -
Analysis 1.2

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

Comparison 1 Pair‐wise comparison, Outcome 3 Honey versus no treatment.
Figuras y tablas -
Analysis 1.3

Comparison 1 Pair‐wise comparison, Outcome 3 Honey versus no treatment.

Comparison 1 Pair‐wise comparison, Outcome 4 Honey versus placebo (Day 1).
Figuras y tablas -
Analysis 1.4

Comparison 1 Pair‐wise comparison, Outcome 4 Honey versus placebo (Day 1).

Comparison 1 Pair‐wise comparison, Outcome 5 Honey versus placebo (Day 2).
Figuras y tablas -
Analysis 1.5

Comparison 1 Pair‐wise comparison, Outcome 5 Honey versus placebo (Day 2).

Comparison 1 Pair‐wise comparison, Outcome 6 Honey versus placebo (Day 3).
Figuras y tablas -
Analysis 1.6

Comparison 1 Pair‐wise comparison, Outcome 6 Honey versus placebo (Day 3).

Comparison 1 Pair‐wise comparison, Outcome 7 Honey versus placebo (Day 4).
Figuras y tablas -
Analysis 1.7

Comparison 1 Pair‐wise comparison, Outcome 7 Honey versus placebo (Day 4).

Comparison 1 Pair‐wise comparison, Outcome 8 Honey versus placebo (Day 5).
Figuras y tablas -
Analysis 1.8

Comparison 1 Pair‐wise comparison, Outcome 8 Honey versus placebo (Day 5).

Comparison 1 Pair‐wise comparison, Outcome 9 Honey versus salbutamol (Day 1).
Figuras y tablas -
Analysis 1.9

Comparison 1 Pair‐wise comparison, Outcome 9 Honey versus salbutamol (Day 1).

Comparison 1 Pair‐wise comparison, Outcome 10 Honey versus salbutamol (Day 2).
Figuras y tablas -
Analysis 1.10

Comparison 1 Pair‐wise comparison, Outcome 10 Honey versus salbutamol (Day 2).

Comparison 1 Pair‐wise comparison, Outcome 11 Honey versus salbutamol (Day 3).
Figuras y tablas -
Analysis 1.11

Comparison 1 Pair‐wise comparison, Outcome 11 Honey versus salbutamol (Day 3).

Comparison 1 Pair‐wise comparison, Outcome 12 Honey versus salbutamol (Day 4).
Figuras y tablas -
Analysis 1.12

Comparison 1 Pair‐wise comparison, Outcome 12 Honey versus salbutamol (Day 4).

Comparison 1 Pair‐wise comparison, Outcome 13 Honey versus salbutamol (Day 5).
Figuras y tablas -
Analysis 1.13

Comparison 1 Pair‐wise comparison, Outcome 13 Honey versus salbutamol (Day 5).

Comparison 2 Pre‐ and postintervention comparison, Outcome 1 Cough frequency (mean reduction in frequency).
Figuras y tablas -
Analysis 2.1

Comparison 2 Pre‐ and postintervention comparison, Outcome 1 Cough frequency (mean reduction in frequency).

Comparison 2 Pre‐ and postintervention comparison, Outcome 2 Severity of cough (mean reduction in severity).
Figuras y tablas -
Analysis 2.2

Comparison 2 Pre‐ and postintervention comparison, Outcome 2 Severity of cough (mean reduction in severity).

Comparison 2 Pre‐ and postintervention comparison, Outcome 3 Bothersome cough (mean reduction in bothersome cough).
Figuras y tablas -
Analysis 2.3

Comparison 2 Pre‐ and postintervention comparison, Outcome 3 Bothersome cough (mean reduction in bothersome cough).

Comparison 2 Pre‐ and postintervention comparison, Outcome 4 Children's sleep (mean reduction in cough impact on sleep score).
Figuras y tablas -
Analysis 2.4

Comparison 2 Pre‐ and postintervention comparison, Outcome 4 Children's sleep (mean reduction in cough impact on sleep score).

Comparison 2 Pre‐ and postintervention comparison, Outcome 5 Parents' sleep (mean reduction in cough impact on sleep score).
Figuras y tablas -
Analysis 2.5

Comparison 2 Pre‐ and postintervention comparison, Outcome 5 Parents' sleep (mean reduction in cough impact on sleep score).

Comparison 2 Pre‐ and postintervention comparison, Outcome 6 Combined reduction in symptoms score.
Figuras y tablas -
Analysis 2.6

Comparison 2 Pre‐ and postintervention comparison, Outcome 6 Combined reduction in symptoms score.

Comparison 3 Adverse events, Outcome 1 Honey versus dextromethorphan.
Figuras y tablas -
Analysis 3.1

Comparison 3 Adverse events, Outcome 1 Honey versus dextromethorphan.

Comparison 3 Adverse events, Outcome 2 Honey versus diphenhydramine.
Figuras y tablas -
Analysis 3.2

Comparison 3 Adverse events, Outcome 2 Honey versus diphenhydramine.

Comparison 3 Adverse events, Outcome 3 Honey versus placebo.
Figuras y tablas -
Analysis 3.3

Comparison 3 Adverse events, Outcome 3 Honey versus placebo.

Comparison 3 Adverse events, Outcome 4 Honey versus salbutamol.
Figuras y tablas -
Analysis 3.4

Comparison 3 Adverse events, Outcome 4 Honey versus salbutamol.

Comparison 3 Adverse events, Outcome 5 Honey versus no treatment.
Figuras y tablas -
Analysis 3.5

Comparison 3 Adverse events, Outcome 5 Honey versus no treatment.

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

Honey compared to dextromethorphan for acute cough in children

Patient or population: acute cough in children
Setting: ambulatory
Intervention: honey
Comparison: dextromethorphan

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with dextromethorphan

Risk with honey

Duration of cough

Not assessed

Frequency of cough1

The mean frequency of cough (reduction in frequency of cough score) was ‐1.54.

MD 0.07 score lower
(1.07 lower to 0.94 higher)

149
(2 RCTs)

⊕⊕⊝⊝
LOW 2, 3

Follow‐up: mean 1 day

Severity of cough1

The mean severity of cough (reduction in severity of cough score) was ‐1.52.

MD 0.13 score lower
(1.25 lower to 0.99 higher)

149
(2 RCTs)

⊕⊕⊝⊝
LOW 2, 3

Follow‐up: mean 1 day

Bothersome cough1

The mean bothersome cough (reduction in bothersome nature of cough score) was ‐1.94.

MD 0.29 score higher
(0.56 lower to 1.14 higher)

69
(1 RCT)

⊕⊕⊕⊝
MODERATE 5

Follow‐up: mean 1 day

Cough impact on children's sleep1

The mean cough impact on children's sleep (cough impact on children' sleep score) was ‐1.75.

MD 0.03 score higher
(1.12 lower to 1.19 higher)

149
(2 RCTs)

⊕⊕⊝⊝
LOW 2, 3

Follow‐up: mean 6 days

Cough impact on parents' sleep1

The mean cough impact on parents' sleep (cough impact on parents' sleep score) was ‐1.97.

MD 0.16 score lower
(0.84 lower to 0.53 higher)

149
(2 RCTs)

⊕⊕⊝⊝
LOW 2, 3

Follow‐up: mean 1 day

Adverse events

Population

Nervousness, insomnia, hyperactivity

3 per 100

8 per 100

(2 to 32)

RR 2.94
(0.74 to 11.71)

149
(2 RCTs)

⊕⊕⊝⊝
LOW 4

Follow‐up: mean 1 day

Stomachache, nausea, and vomiting

1 per 100

7 per 100

(0 to 100)

RR 4.86
(0.24 to 97.69)

69
(1 RCT)

⊕⊕⊝⊝
LOW 5

Drowsiness

1 per 100

4 per 100
(0 to 100)

RR 2.92
(0.12 to 69.20)

69
(1 RCT)

⊕⊕⊝⊝
LOW 5

*The risk in the intervention group (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; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1Assessed on a 7‐point Likert scale from 0 to 6; lower score is better.
2Downgraded by one level because of study limitations: it was unclear if Shadkam 2010 concealed allocation; there was no blinding, which could increase the risk of bias in the study outcomes.
3Downgraded by one level for serious heterogeneity, which could be due to difference in dextromethorphan dose. In Paul 2007, 8.5 mg/2.5 mL dextromethorphan was given compared to 7.5 mg/2.5 mL given to children aged under 5 years by Shadkam 2010.
4Downgraded by two levels for risk of bias, inconsistency, and imprecision; the studies were underpowered to detect differences.
5Downgraded by two levels for very serious imprecision. Data were available from only Paul 2007, which had a small sample size.

Figuras y tablas -
Summary of findings for the main comparison. Honey compared to dextromethorphan for acute cough in children
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: acute cough in children
Setting: ambulatory
Intervention: honey
Comparison: diphenhydramine

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with diphenhydramine

Risk with honey

Cough duration

Not assessed

Frequency of cough1

The mean frequency of cough (reduction in cough frequency score) was ‐1.73.

MD 0.57 lower
(0.9 lower to 0.24 lower)

80
(1 RCT)

⊕⊕⊝⊝
LOW 2, 3

Follow‐up: mean 1 day

Severity of cough1

The mean severity of cough (reduction in cough severity score) was ‐1.83.

MD 0.6 lower
(0.94 lower to 0.26 lower)

80
(1 RCT)

⊕⊕⊝⊝
LOW 2, 3

Follow‐up: mean 1 day

Cough impact on children's sleep1

The mean cough impact on children's sleep (cough impact on children' sleep score) was ‐1.64.

MD 0.55 score lower
(0.87 lower to 0.23 lower)

80
(1 RCT)

⊕⊕⊝⊝
LOW 2, 3

Follow‐up: mean 6 days

Cough impact on parents' sleep1

The mean cough impact on parents' sleep (cough impact on parents' sleep score) was ‐1.89.

MD 0.48 lower
(0.76 lower to 0.2 lower)

80
(1 RCT)

⊕⊕⊝⊝
LOW 2, 3

Follow‐up: mean 1 day

Adverse event: Somnolence

Population

1 per 100
(0 to 20)

RR 0.14
(0.01 to 2.68)

80
(1 RCT)

⊕⊕⊝⊝
LOW 2, 3

Follow‐up: mean 1 day

8 per 100

*The risk in the intervention group (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; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1Assessed on a 7‐point Likert scale from 0 to 6; lower score is better.
2Downgraded by one level because of study limitations: it was unclear if Shadkam 2010 concealed allocation; there was no blinding, which could increase the risk of bias in the study outcomes.
3Downgraded by one level for serious imprecision: data were from one small study (Shadkam 2010).

Figuras y tablas -
Summary of findings 2. Honey compared to diphenhydramine for acute cough in children
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: acute cough in children
Setting: ambulatory
Intervention: honey
Comparison: 'no treatment'

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with no treatment

Risk with honey

Cough duration

Not assessed

Frequency of cough1

The mean frequency of cough (reduction in cough frequency score) was ‐0.98.

MD 1.05 lower
(1.48 lower to 0.62 lower)

154
(2 RCTs)

⊕⊕⊕⊝
MODERATE 2, 3

Follow‐up: mean 1 day

Severity of cough1

assessed with: 7‐point Likert scale
Scale from 0 to 6

The mean severity of cough (reduction in severity of cough score) was ‐1.13.

MD 1.03 score lower
(1.59 lower to 0.47 lower)

154
(2 RCTs)

⊕⊕⊕⊝
MODERATE 2, 3

Follow‐up: mean 1 day

Bothersome cough1
assessed with: 7‐point Likert scale
Scale from 0 to 6

The mean bothersome cough (reduction in bothersome nature of cough score) was ‐1.30.

MD 0.93 score lower
(1.98 lower to 0.12 higher)

74
(1 RCT)

⊕⊕⊝⊝
LOW 2, 4

Follow‐up: mean 1 day

Cough impact on children's sleep1
assessed with: 7‐point Likert scale
Scale from 0 to 6

The mean cough impact on children's sleep (cough impact on children' sleep score) was ‐1.28.

MD 1.04 score lower
(1.57 lower to 0.51 lower)

154
(2 RCTs)

⊕⊕⊕⊝
MODERATE 2, 3

Follow‐up: mean 6 days

Cough impact on parents' sleep1

assessed with: 7‐point Likert scale
Scale from 0 to 6

The mean cough impact on parents' sleep (cough impact on parents' sleep score) was ‐1.46.

MD 0.88 score lower
(1.23 lower to 0.52 lower)

154
(2 RCTs)

⊕⊕⊕⊝
MODERATE 2, 3

Follow‐up: mean 1 day

Adverse events

Population

Nervousness, insomnia, hyperactivity

1 per 100

6 per 100
(1 to 33)

RR 9.40 (1.16 to 76.20)

154
(2 RCTs)

⊕⊕⊝⊝
LOW 2, 4

Follow‐up: mean 1 day

Stomachache, nausea, and vomiting

1 per 100

7 per 100
(0 to 62)

RR 5.90 (0.27 to 127.14)

74
(1 RCT)

⊕⊕⊝⊝
LOW 2, 4

Drowsiness

1 per 100

4 per 100
(0 to 53)

RR 3.43 (0.14 to 87.09)

74
(1 RCT)

⊕⊕⊝⊝
LOW 2, 4

*The risk in the intervention group (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; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1Assessed on a 7‐point Likert scale from 0 to 6; lower score is better.
2Downgraded by one level for risk of bias. Participants in the no‐treatment arm were not blinded; knowledge of receiving no treatment may have influenced assessment of this subjective outcome (Paul 2007; Shadkam 2010).
3Downgraded by one level for imprecision and risk of bias.
4Downgraded by one level for serious imprecision: data from one small study (Paul 2007).

Figuras y tablas -
Summary of findings 3. Honey compared to no treatment for acute cough in children
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: acute cough in children
Setting: ambulatory
Intervention: honey
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo

Risk with honey

Day 1

Frequency of cough1

The mean frequency of cough (reduction in cough frequency score) was ‐0.99.

MD 1.62 score lower
(3.02 lower to 0.22 lower)

402
(2 RCT)

⊕⊕⊕⊝
MODERATE 2

Follow‐up: mean 1 day

Severity of cough1

The mean severity of cough (reduction in severity of cough score) was ‐0.80.

MD 1.07 score lower
(2.43 lower to 0.3 higher)

402
(2 RCT)

⊕⊕⊕⊝
MODERATE 2

Bothersome cough (mean improvement score)1

The mean bothersome cough (reduction in bothersome nature of cough) was ‐1.08.

MD 1.4 score lower
(2.82 lower to 0.03 higher)

402
(2 RCTs)

⊕⊕⊕⊝
MODERATE 2

Cough impact on children's sleep1

The mean cough impact on children's sleep (cough impact on children' sleep score) was ‐1.03.

MD 1.21 score lower
(2.61 lower to 0.19 higher)

402
(2 RCTs)

⊕⊕⊕⊝
MODERATE 2

Follow‐up: mean 6 days

Cough impact on parents' sleep1

The mean cough impact on parents' sleep (cough impact on parents' sleep score) was ‐1.44.

MD 1.29 score lower
(2.71 lower to 0.13 higher)

402
(2 RCTs)

⊕⊕⊕⊝
MODERATE 2

Follow‐up: mean 1 day

Day 3

Frequency of cough1

The mean frequency of cough (reduction in frequency of cough score) was ‐0.9.

MD 1.13 score lower
(1.71 lower to 0.55 lower)

102
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Follow‐up: mean 6 days

Severity of cough1

The mean severity of cough (reduction in severity of cough score) was ‐1.08.

MD 0.85 score lower
(1.41 lower to 0.29 lower)

102
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Bothersome cough1

The mean bothersome cough (reduction in bothersome nature of cough score) was ‐0.99.

MD 1.33 score lower
(1.87 lower to 0.79 lower)

102
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Cough impact on children's sleep1

The mean cough impact on children's sleep (cough impact on children's sleep score) was ‐0.46.

MD 0.93 score lower
(1.42 lower to 0.44 lower)

102
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Cough impact on parents' sleep3

The mean cough impact on parents' sleep (cough impact on parents' sleep score) was ‐1.04.

MD 0.88 score lower
(1.38 lower to 0.38 lower)

102
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Day 5

Cough duration

The mean cough duration was 5.18 days.

MD 0.72 days lower
(1.31 lower to 0.13 lower)

102
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Follow‐up: mean 6 days; assessed with: 7‐point Likert scale
Scale from 0 to 6

Frequency of cough1

The mean frequency of cough (reduction in frequency of cough score) was ‐1.95.

MD 0.48 score lower
(2.95 lower to 1.99 higher)

102
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Severity of cough1

The mean severity of cough (reduction in severity of cough score) was ‐1.96.

MD 0.43 score lower
(2.21 lower to 1.35 higher)

102
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Bothersome cough1

The mean bothersome cough (reduction in bothersome nature of cough score) was ‐1.85.

MD 0.51 score lower
(3.01 lower to 1.99 higher)

102
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Cough impact on children's sleep1

The mean cough impact on children's sleep (cough impact on children' sleep score) was ‐1.68.

MD 0.55 score lower
(1.79 lower to 0.69 higher)

102
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Cough impact on parents' sleep

The mean cough impact on parents' sleep (cough impact on parents' sleep score) was ‐1.54.

MD 0.57 score lower
(1.59 lower to 0.45 higher)

102
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Adverse events

Population

Stomachache, nausea, and vomiting

11 per 100

21 per 100
(12 to 35)

RR 1.91
(1.12 to 3.24)

402
(2 RCTs)

⊕⊕⊕⊝
MODERATE2

Follow‐up: mean 6 days

Diarrhoea

13 per 100

12 per 100
(4 to 34)

RR 0.92
(0.33 to 2.55)

102
(1 RCT)

⊕⊕⊝⊝
LOW 3

Tachycardia

2 per 100

4 per 100
(0 to 37)

RR 1.58
(0.15 to 16.86)

102
(1 RCT)

⊕⊕⊝⊝
LOW 3

*The risk in the intervention group (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; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1Assessed on a 7‐point Likert scale from 0 to 6; lower score is better.
2Downgraded by one level for serious imprecision.
3Downgraded by two levels for very serious imprecision: Waris 2014 was insufficiently powered to detect differences.

Figuras y tablas -
Summary of findings 4. Honey compared to placebo for acute cough in children
Summary of findings 5. Honey compared to salbutamol for acute cough in children

Honey compared to salbutamol for acute cough in children

Patient or population: acute cough in children
Setting: ambulatory
Intervention: honey
Comparison: salbutamol

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with salbutamol

Risk with honey

Day 1

Frequency of cough (mean improvement score)1

The mean frequency of cough (reduction in frequency of cough score) was ‐0.52.

MD 0.26 lower
(3.14 lower to 2.62 higher)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Follow‐up: mean 6 days

Severity of cough (mean improvement score)1

The mean severity of cough (reduction in severity of cough score) was ‐0.74.

MD 0.1 lower
(0.39 lower to 0.19 higher)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Bothersome cough (mean improvement score)1

The mean bothersome cough (reduction in bothersome nature of cough score) was ‐1.00.

MD 0.21 lower
(0.9 lower to 0.48 higher)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Cough impact on children's sleep1

The mean cough impact on children's sleep (cough impact on children' sleep score) was ‐1.24.

MD 0.09 higher
(0.05 lower to 0.23 higher)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Cough impact on parents' sleep1

The mean cough impact on parents' sleep (cough impact on parents' sleep score) was ‐1.22.

MD 0.05 higher
(0.03 lower to 0.13 higher)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Day 3

Frequency of cough1

The mean frequency of cough (reduction in frequency of cough score) was ‐1.34.

MD 0.69 lower
(1.13 lower to 0.25 lower)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Follow‐up: mean 4 days

Severity of cough1

The mean severity of cough (reduction in severity of cough score) was ‐1.59.

MD 0.34 lower
(0.64 lower to 0.04 lower)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Bothersome cough1

The mean bothersome cough (reduction in bothersome nature of cough score) was ‐2.08.

MD 0.24 lower
(0.38 lower to 0.1 lower)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Cough impact on children's sleep1

The mean cough impact on children's sleep (cough impact on children' sleep score) was ‐2.25.

MD 0.31 higher
(0.13 higher to 0.49 higher)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Follow‐up: mean 6 days

Cough impact on parents' sleep1

The mean cough impact on parents' sleep (cough impact on parents' sleep score) was ‐2.13.

MD 0.21 higher
(0.06 higher to 0.36 higher)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Follow‐up: mean 4 days

Day 5

Cough duration
assessed (days)

The mean cough duration was 5 days.

MD 0.54 days lower
(0.98 lower to 0.1 lower)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Follow‐up: mean 6 days

Frequency of cough (mean improvement score)1

The mean frequency of cough (reduction in frequency of cough score) was ‐2.19.

MD 0.54 lower
(1.03 lower to 0.05 lower)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Severity of cough (mean improvement score)1

The mean severity of cough (reduction in severity of cough score) was ‐2.08.

MD 0.41 lower
(0.78 lower to 0.04 lower)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Bothersome cough (mean improvement score)1

The mean bothersome cough (reduction in bothersome nature of cough score) was ‐2.47.

MD 0.27 lower
(0.48 lower to 0.06 lower)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Cough impact on children's sleep1

The mean cough impact on children's sleep (cough impact on children's sleep score) was ‐2.47.

MD 0.15 higher
(0.04 higher to 0.26 higher)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Cough impact on parents' sleep1

The mean cough impact on parents' sleep (cough impact on parents' sleep score) was ‐2.33.

MD 0.04 higher
(0.01 higher to 0.07 higher)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Adverse events

Population

Stomachache, nausea, and vomiting

30 per 100

53 per 100
(31 to 88)

RR 1.74
(1.04 to 2.92)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Follow‐up: mean 6 days

Rash

9 per 100

2 per 100
(0 to 15)

RR 0.19
(0.02 to 1.63)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

Tachycardia

2 per 100

4 per 100
(0 to 39)

RR 1.51 (0.14 to 16.10)

100
(1 RCT)

⊕⊕⊝⊝
LOW 3

Diarrhoea

21 per 100

12 per 100
(5 to 30)

RR 0.59
(0.24 to 1.45)

100
(1 RCT)

⊕⊕⊕⊝
MODERATE 2

*The risk in the intervention group (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; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1Assessed on a 7‐point Likert scale from 0 to 6; lower score is better.
2Downgraded by one level for serious imprecision. Data were from one small study (Waris 2014).
3Downgraded by two levels for very serious imprecision. Data were from one small study (Waris 2014).

Figuras y tablas -
Summary of findings 5. Honey compared to salbutamol for acute cough in children
Table 1. Pre‐ and postintervention comparison of honey on cough frequency and severity expressed as medians

Study ID

Cough

Honey

(N = 29)

Bromelin
(pineapple extract) + honey

(N = 31)

P value

Certainty of the evidence

Peixoto 2016

Frequency of cough1

Before, median (P25 to P75)

After, median (P25 to P75)

Mean ± SD

3 (2 to 4)

1 (1 to 1)

1.76 ± 0.87

3 (2 to 3)

1 (1 to 1)

1.71 ± 0.78

0.832

0.943

⊕⊕⊕⊝
MODERATE 4

Severity of cough1

Mean ± SD

assessed with: unvalidated 5‐point cough scale from 0 to 4

‐0.86 ± 0.45

‐0.97 ± 0.62

0.322 0.223

⊕⊕⊕⊝
MODERATE 4

Honey

(N = 63)

Diphenhydramine

(N = 63)

Ahmadi 2013

Proportion of children with reduction in frequency and severity of daytime cough5

84.1%

(N = 53)

58.7% (N = 37)

"< 0.02"

⊕⊕⊕⊝
MODERATE 4

Proportion of children with reduction in frequency and severity of nighttime cough5

79.4%

(N = 50)

58.7% (N = 37)

"< 0.02"

⊕⊕⊕⊝
MODERATE 4

SD: standard deviation
P: percentile

1Assessed on an unvalidated 5‐point cough scale from 0 to 4; lower score is better.
2Student's t test.
3Chi².
4Downgraded by one level for risk of bias and imprecision.
5Assessed on a 7‐point Likert scale from 0 to 6; lower score is better.

Figuras y tablas -
Table 1. Pre‐ and postintervention comparison of honey on cough frequency and severity expressed as medians
Comparison 1. 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 reduction in cough frequency)

2

149

Mean Difference (Random, 95% CI)

‐0.07 [‐1.07, 0.94]

1.2 Severity of cough (mean reduction in severity of cough)

2

149

Mean Difference (Random, 95% CI)

‐0.13 [‐1.25, 0.99]

1.3 Bothersome cough (mean reduction in bothersome cough)

1

69

Mean Difference (Random, 95% CI)

0.29 [‐0.56, 1.14]

1.4 Children's sleep (mean reduction in cough impact on sleep score)

2

149

Mean Difference (Random, 95% CI)

0.03 [‐1.12, 1.19]

1.5 Parents' sleep (mean reduction in cough impact on sleep score)

2

149

Mean Difference (Random, 95% CI)

‐0.16 [‐0.84, 0.53]

1.6 Combined cough score (reduction in combined cough score)

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 reduction in cough frequency)

1

80

Mean Difference (Random, 95% CI)

‐0.57 [‐0.90, ‐0.24]

2.2 Severity of cough (mean reduction in severity of cough)

1

80

Mean Difference (Random, 95% CI)

‐0.6 [‐0.94, ‐0.26]

2.3 Children's sleep (mean reduction in cough impact on sleep score)

1

80

Mean Difference (Random, 95% CI)

‐0.55 [‐0.87, ‐0.23]

2.4 Parents' sleep (mean reduction in cough impact on 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 reduction in frequency of cough)

2

154

Mean Difference (Random, 95% CI)

‐1.05 [‐1.48, ‐0.62]

3.2 Severity of cough (mean reduction in severity of cough)

2

154

Mean Difference (Random, 95% CI)

‐1.03 [‐1.59, ‐0.47]

3.3 Bothersome cough (mean reduction in bothersome cough)

1

74

Mean Difference (Random, 95% CI)

‐0.93 [‐1.98, 0.12]

3.4 Children's sleep (mean reduction in cough impact on sleep score)

2

154

Mean Difference (Random, 95% CI)

‐1.04 [‐1.57, ‐0.51]

3.5 Parents' sleep (mean reduction in cough impact on sleep score)

2

154

Mean Difference (Random, 95% CI)

‐0.88 [‐1.23, ‐0.52]

3.6 Combined reduction in symptoms score

1

74

Mean Difference (Random, 95% CI)

‐4.31 [‐6.77, ‐1.85]

4 Honey versus placebo (Day 1) Show forest plot

2

Mean Difference (Random, 95% CI)

Subtotals only

4.1 Frequency of cough (mean reduction in frequency of cough)

2

402

Mean Difference (Random, 95% CI)

‐1.62 [‐3.02, ‐0.22]

4.2 Severity of cough (mean reduction in severity of cough)

2

402

Mean Difference (Random, 95% CI)

‐1.07 [‐2.43, 0.30]

4.3 Bothersome cough (mean reduction in bothersome cough)

2

402

Mean Difference (Random, 95% CI)

‐1.40 [‐2.82, 0.03]

4.4 Children's sleep (mean reduction in cough impact on sleep score)

2

402

Mean Difference (Random, 95% CI)

‐1.21 [‐2.61, 0.19]

4.5 Parents' sleep (mean reduction in cough impact on sleep score)

2

402

Mean Difference (Random, 95% CI)

‐1.29 [‐2.71, 0.13]

5 Honey versus placebo (Day 2) Show forest plot

1

Mean Difference (Random, 95% CI)

Subtotals only

5.1 Frequency of cough (mean reduction in frequency of cough)

1

102

Mean Difference (Random, 95% CI)

‐0.71 [‐1.22, ‐0.20]

5.2 Severity of cough (mean reduction in severity of cough)

1

102

Mean Difference (Random, 95% CI)

‐0.63 [‐1.36, 0.10]

5.3 Bothersome cough (mean reduction in bothersome cough)

1

102

Mean Difference (Random, 95% CI)

‐1.11 [‐1.79, ‐0.43]

5.4 Children's sleep (mean reduction in cough impact on sleep score)

1

102

Mean Difference (Random, 95% CI)

‐0.69 [‐1.43, 0.05]

5.5 Parents' sleep (mean reduction in cough impact on sleep score)

1

102

Mean Difference (Random, 95% CI)

‐0.87 [‐1.59, ‐0.15]

6 Honey versus placebo (Day 3) Show forest plot

1

Mean Difference (Random, 95% CI)

Subtotals only

6.1 Frequency of cough (mean reduction in frequency of cough)

1

102

Mean Difference (Random, 95% CI)

‐1.13 [‐1.71, ‐0.55]

6.2 Severity of cough (mean reduction in severity of cough)

1

102

Mean Difference (Random, 95% CI)

‐0.85 [‐1.41, ‐0.29]

6.3 Bothersome cough (mean reduction in bothersome cough)

1

102

Mean Difference (Random, 95% CI)

‐1.33 [‐1.87, ‐0.79]

6.4 Children's sleep (mean reduction in cough impact on sleep score)

1

102

Mean Difference (Random, 95% CI)

‐0.93 [‐1.42, ‐0.44]

6.5 Parents' sleep (mean reduction in cough impact on sleep score)

1

102

Mean Difference (Random, 95% CI)

‐0.88 [‐1.38, ‐0.38]

7 Honey versus placebo (Day 4) Show forest plot

1

Mean Difference (Random, 95% CI)

Subtotals only

7.1 Frequency of cough (mean reduction in frequency of cough)

1

102

Mean Difference (Random, 95% CI)

‐1.16 [‐1.83, ‐0.49]

7.2 Severity of cough (mean reduction in severity of cough)

1

102

Mean Difference (Random, 95% CI)

‐0.88 [‐1.59, ‐0.17]

7.3 Bothersome cough (mean reduction in bothersome cough)

1

102

Mean Difference (Random, 95% CI)

‐0.90 [‐1.76, ‐0.04]

7.4 Children's sleep (mean reduction in cough impact on sleep score)

1

102

Mean Difference (Random, 95% CI)

‐0.7 [‐1.25, ‐0.15]

7.5 Parents' sleep (mean reduction in cough impact on sleep score)

1

102

Mean Difference (Random, 95% CI)

‐0.90 [‐1.51, ‐0.29]

8 Honey versus placebo (Day 5) Show forest plot

1

Mean Difference (Random, 95% CI)

Subtotals only

8.1 Cough duration (mean number of days)

1

102

Mean Difference (Random, 95% CI)

‐0.72 [‐1.31, ‐0.13]

8.2 Frequency of cough (mean reduction in frequency of cough)

1

102

Mean Difference (Random, 95% CI)

‐0.48 [‐2.95, 1.99]

8.3 Severity of cough (mean reduction in severity of cough)

1

102

Mean Difference (Random, 95% CI)

‐0.43 [‐2.21, 1.35]

8.4 Bothersome cough (mean reduction in bothersome cough)

1

102

Mean Difference (Random, 95% CI)

‐0.51 [‐3.01, 1.99]

8.5 Children's sleep (mean reduction in cough impact on sleep score)

1

102

Mean Difference (Random, 95% CI)

‐0.55 [‐1.79, 0.69]

8.6 Parents' sleep (mean reduction in cough impact on sleep score)

1

102

Mean Difference (Random, 95% CI)

‐0.57 [‐1.59, 0.45]

9 Honey versus salbutamol (Day 1) Show forest plot

1

Mean Difference (Random, 95% CI)

Subtotals only

9.1 Frequency of cough (mean reduction in frequency of cough)

1

100

Mean Difference (Random, 95% CI)

‐0.26 [‐3.14, 2.62]

9.2 Severity of cough (mean reduction in severity of cough)

1

100

Mean Difference (Random, 95% CI)

‐0.1 [‐0.39, 0.19]

9.3 Bothersome cough (mean reduction in bothersome cough)

1

100

Mean Difference (Random, 95% CI)

‐0.21 [‐0.90, 0.48]

9.4 Children's sleep (mean reduction in cough impact on sleep score)

1

100

Mean Difference (Random, 95% CI)

0.09 [‐0.05, 0.23]

9.5 Parents' sleep (mean reduction in cough impact on sleep score)

1

100

Mean Difference (Random, 95% CI)

0.05 [‐0.03, 0.13]

10 Honey versus salbutamol (Day 2) Show forest plot

1

Mean Difference (Random, 95% CI)

Subtotals only

10.1 Frequency of cough (mean reduction in frequency of cough)

1

100

Mean Difference (Random, 95% CI)

‐0.67 [‐1.35, 0.01]

10.2 Severity of cough (mean reduction in severity of cough)

1

100

Mean Difference (Random, 95% CI)

‐0.42 [‐1.16, 0.32]

10.3 Bothersome cough (mean reduction in bothersome cough)

1

100

Mean Difference (Random, 95% CI)

‐0.27 [‐0.52, ‐0.02]

10.4 Children's sleep (mean reduction in cough impact on sleep score)

1

100

Mean Difference (Random, 95% CI)

0.17 [‐0.04, 0.38]

10.5 Parents' sleep (mean reduction in cough impact on sleep score)

1

100

Mean Difference (Random, 95% CI)

0.03 [‐0.00, 0.06]

11 Honey versus salbutamol (Day 3) Show forest plot

1

Mean Difference (Random, 95% CI)

Subtotals only

11.1 Frequency of cough (mean reduction in frequency of cough)

1

100

Mean Difference (Random, 95% CI)

‐0.69 [‐1.13, ‐0.25]

11.2 Severity of cough (mean reduction in severity of cough)

1

100

Mean Difference (Random, 95% CI)

‐0.34 [‐0.64, ‐0.04]

11.3 Bothersome cough (mean reduction in bothersome cough)

1

100

Mean Difference (Random, 95% CI)

‐0.24 [‐0.38, ‐0.10]

11.4 Children's sleep (mean reduction in cough impact on sleep score)

1

100

Mean Difference (Random, 95% CI)

0.31 [0.13, 0.49]

11.5 Parents' sleep (mean reduction in cough impact on sleep score)

1

100

Mean Difference (Random, 95% CI)

0.21 [0.06, 0.36]

12 Honey versus salbutamol (Day 4) Show forest plot

1

Mean Difference (Random, 95% CI)

Subtotals only

12.1 Frequency of cough (mean reduction in frequency of cough)

1

100

Mean Difference (Random, 95% CI)

‐0.61 [‐0.96, ‐0.26]

12.2 Severity of cough (mean reduction in severity of cough)

1

100

Mean Difference (Random, 95% CI)

‐0.43 [‐0.78, ‐0.08]

12.3 Bothersome cough (mean reduction in bothersome cough)

1

100

Mean Difference (Random, 95% CI)

‐0.3 [‐0.59, ‐0.01]

12.4 Children's sleep (mean reduction in cough impact on sleep score)

1

100

Mean Difference (Random, 95% CI)

0.22 [0.05, 0.39]

12.5 Parents' sleep (mean reduction in cough impact on sleep score)

1

100

Mean Difference (Random, 95% CI)

0.15 [0.04, 0.26]

13 Honey versus salbutamol (Day 5) Show forest plot

1

Mean Difference (Random, 95% CI)

Subtotals only

13.1 Cough duration (mean number of days)

1

100

Mean Difference (Random, 95% CI)

‐0.54 [‐0.98, ‐0.10]

13.2 Frequency of cough (mean reduction in frequency of cough)

1

100

Mean Difference (Random, 95% CI)

‐0.54 [‐1.03, ‐0.05]

13.3 Severity of cough (mean reduction in severity of cough)

1

100

Mean Difference (Random, 95% CI)

‐0.41 [‐0.78, ‐0.04]

13.4 Bothersome cough (mean reduction in bothersome cough)

1

100

Mean Difference (Random, 95% CI)

‐0.27 [‐0.48, ‐0.06]

13.5 Children's sleep (mean reduction in cough impact on sleep score)

1

100

Mean Difference (Random, 95% CI)

0.15 [0.04, 0.26]

13.6 Parents' sleep (mean reduction in cough impact on sleep score)

1

100

Mean Difference (Random, 95% CI)

0.04 [0.01, 0.07]

Figuras y tablas -
Comparison 1. Pair‐wise comparison
Comparison 2. Pre‐ and postintervention comparison

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cough frequency (mean reduction in frequency) Show forest plot

4

Mean Difference (Fixed, 95% CI)

Subtotals only

1.1 Honey

4

357

Mean Difference (Fixed, 95% CI)

‐1.71 [‐2.28, ‐1.13]

1.2 Dextromethorphan

2

74

Mean Difference (Fixed, 95% CI)

‐1.54 [‐2.30, ‐0.78]

1.3 Diphenhydramine

1

40

Mean Difference (Fixed, 95% CI)

‐1.73 [‐2.72, ‐0.74]

1.4 Placebo

2

120

Mean Difference (Fixed, 95% CI)

‐0.99 [‐1.79, ‐0.18]

1.5 Salbutamol Day 1

1

43

Mean Difference (Fixed, 95% CI)

‐0.52 [‐6.28, 5.24]

1.6 No treatment

2

79

Mean Difference (Fixed, 95% CI)

‐0.98 [‐1.38, ‐0.59]

1.7 Buckwheat honey

1

35

Mean Difference (Fixed, 95% CI)

‐1.89 [‐2.96, ‐0.81]

1.8 Natural honey from Kafi‐Abad (Iran)

1

40

Mean Difference (Fixed, 95% CI)

‐2.16 [‐3.40, ‐0.92]

1.9 Eucalyptus honey

1

75

Mean Difference (Fixed, 95% CI)

‐1.77 [‐3.22, ‐0.32]

1.10 Labiatae honey

1

75

Mean Difference (Fixed, 95% CI)

‐1.82 [‐3.30, ‐0.34]

1.11 Citrus honey

1

75

Mean Difference (Fixed, 95% CI)

‐1.95 [‐3.55, ‐0.35]

1.12 Salbutamol Day 5

1

43

Mean Difference (Fixed, 95% CI)

‐2.19 [‐3.55, ‐0.83]

1.13 African honey Day 5

1

57

Mean Difference (Fixed, 95% CI)

‐2.65 [‐4.32, ‐0.98]

1.14 Placebo Day 5

1

45

Mean Difference (Fixed, 95% CI)

‐1.95 [‐4.42, 0.52]

2 Severity of cough (mean reduction in severity) Show forest plot

4

Mean Difference (Fixed, 95% CI)

Subtotals only

2.1 Honey

4

357

Mean Difference (Fixed, 95% CI)

‐1.65 [‐2.39, ‐0.91]

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 Salbutamol Day 1

1

43

Mean Difference (Fixed, 95% CI)

‐0.74 [‐2.87, 1.39]

2.5 No treatment

2

79

Mean Difference (Fixed, 95% CI)

‐1.13 [‐1.54, ‐0.72]

2.6 Placebo

2

120

Mean Difference (Fixed, 95% CI)

‐0.80 [‐1.47, ‐0.13]

2.7 Buckwheat honey

1

35

Mean Difference (Fixed, 95% CI)

‐1.80 [‐2.88, ‐0.72]

2.8 Natural honey from Kafi‐Abad (Iran)

1

40

Mean Difference (Fixed, 95% CI)

‐2.33 [‐3.67, ‐0.99]

2.9 Eucalyptus honey

1

75

Mean Difference (Fixed, 95% CI)

‐1.78 [‐2.82, ‐0.74]

2.10 Labiatae honey

1

75

Mean Difference (Fixed, 95% CI)

‐1.94 [‐3.07, ‐0.81]

2.11 Citrus honey

1

75

Mean Difference (Fixed, 95% CI)

‐1.77 [‐2.74, ‐0.80]

2.12 Salbutamol Day 5

1

43

Mean Difference (Fixed, 95% CI)

‐2.08 [‐4.21, 0.05]

2.13 African honey Day 5

1

57

Mean Difference (Fixed, 95% CI)

‐2.62 [‐5.04, ‐0.20]

2.14 Placebo Day 5

1

45

Mean Difference (Fixed, 95% CI)

‐1.96 [‐3.74, ‐0.18]

3 Bothersome cough (mean reduction in bothersome cough) Show forest plot

3

Mean Difference (Fixed, 95% CI)

Subtotals only

3.1 Honey

3

317

Mean Difference (Fixed, 95% CI)

‐2.22 [‐3.24, ‐1.21]

3.2 Dextromethorphan

1

34

Mean Difference (Fixed, 95% CI)

‐1.94 [‐3.05, ‐0.83]

3.3 Salbutamol Day 1

1

43

Mean Difference (Fixed, 95% CI)

‐1.0 [‐4.28, 2.28]

3.4 No treatment

1

39

Mean Difference (Fixed, 95% CI)

‐1.30 [‐2.07, ‐0.53]

3.5 Placebo

2

120

Mean Difference (Fixed, 95% CI)

‐1.08 [‐2.06, ‐0.10]

3.6 Buckwheat honey

1

35

Mean Difference (Fixed, 95% CI)

‐2.23 [‐3.50, ‐0.96]

3.7 Eucalyptus honey

1

75

Mean Difference (Fixed, 95% CI)

‐2.0 [‐3.82, ‐0.18]

3.8 Labiatae honey

1

75

Mean Difference (Fixed, 95% CI)

‐2.07 [‐4.03, ‐0.11]

3.9 Citrus honey

1

75

Mean Difference (Fixed, 95% CI)

‐2.16 [‐4.20, ‐0.12]

3.10 Salbutamol Day 5

1

43

Mean Difference (Fixed, 95% CI)

‐2.47 [‐4.73, ‐0.21]

3.11 African honey Day 5

1

57

Mean Difference (Fixed, 95% CI)

‐2.74 [‐5.27, ‐0.21]

3.12 Placebo Day 5

1

45

Mean Difference (Fixed, 95% CI)

‐1.85 [‐3.56, ‐0.14]

4 Children's sleep (mean reduction in cough impact on sleep score) Show forest plot

4

Mean Difference (Random, 95% CI)

Subtotals only

4.1 Honey

4

357

Mean Difference (Random, 95% CI)

‐2.23 [‐2.87, ‐1.59]

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

2

120

Mean Difference (Random, 95% CI)

‐1.03 [‐2.05, 0.00]

4.6 Salbutamol Day 5

1

43

Mean Difference (Random, 95% CI)

‐2.47 [‐3.84, ‐1.10]

4.7 African honey Day 5

1

57

Mean Difference (Random, 95% CI)

‐2.32 [‐3.63, ‐1.01]

4.8 Placebo Day 5

1

45

Mean Difference (Random, 95% CI)

‐1.68 [‐2.63, ‐0.73]

5 Parents' sleep (mean reduction in cough impact on sleep score) Show forest plot

4

Mean Difference (Fixed, 95% CI)

Subtotals only

5.1 Honey

4

357

Mean Difference (Fixed, 95% CI)

‐2.25 [‐2.89, ‐1.61]

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

2

120

Mean Difference (Fixed, 95% CI)

‐1.44 [‐2.28, ‐0.61]

5.6 Salbutamol Day 5

1

43

Mean Difference (Fixed, 95% CI)

‐2.33 [‐3.91, ‐0.75]

5.7 African honey Day 5

1

57

Mean Difference (Fixed, 95% CI)

‐2.29 [‐3.86, ‐0.72]

5.8 Placebo Day 5

1

45

Mean Difference (Fixed, 95% CI)

‐1.54 [‐2.60, ‐0.48]

6 Combined reduction in symptoms score Show forest plot

3

Mean Difference (Fixed, 95% CI)

Subtotals only

6.1 Honey

3

317

Mean Difference (Fixed, 95% CI)

‐10.60 [‐14.43, ‐6.77]

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

2

132

Mean Difference (Fixed, 95% CI)

‐7.11 [‐10.78, ‐3.44]

6.5 Honey Day 5

1

57

Mean Difference (Fixed, 95% CI)

‐12.68 [‐14.06, ‐11.30]

6.6 Placebo Day 5

1

45

Mean Difference (Fixed, 95% CI)

‐8.69 [‐14.17, ‐3.21]

6.7 Salbutamol Day 5

1

43

Mean Difference (Fixed, 95% CI)

‐11.37 [‐17.55, ‐5.19]

Figuras y tablas -
Comparison 2. Pre‐ and postintervention comparison
Comparison 3. Adverse events

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Honey versus dextromethorphan Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Nervousness, insomnia, hyperactivity

2

149

Risk Ratio (M‐H, Fixed, 95% CI)

2.94 [0.74, 11.71]

1.2 Stomachache, nausea, and vomiting

1

69

Risk Ratio (M‐H, Fixed, 95% CI)

4.86 [0.24, 97.69]

1.3 Drowsiness

1

69

Risk Ratio (M‐H, Fixed, 95% CI)

2.92 [0.12, 69.20]

2 Honey versus diphenhydramine Show forest plot

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.01, 2.68]

2.1 Somnolence

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.01, 2.68]

3 Honey versus placebo Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Stomachache, nausea, and vomiting

2

402

Risk Ratio (M‐H, Fixed, 95% CI)

1.91 [1.12, 3.24]

3.2 Diarrhoea

1

102

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.33, 2.55]

3.3 Tachycardia

1

102

Risk Ratio (M‐H, Fixed, 95% CI)

1.58 [0.15, 16.86]

4 Honey versus salbutamol Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Stomachache, nausea, and vomiting

1

100

Risk Ratio (M‐H, Random, 95% CI)

1.74 [1.04, 2.92]

4.2 Rash

1

100

Risk Ratio (M‐H, Random, 95% CI)

0.19 [0.02, 1.63]

4.3 Tachycardia

1

100

Risk Ratio (M‐H, Random, 95% CI)

1.51 [0.14, 16.10]

4.4 Diarrhoea

1

100

Risk Ratio (M‐H, Random, 95% CI)

0.59 [0.24, 1.45]

5 Honey versus no treatment Show forest plot

2

302

Odds Ratio (M‐H, Fixed, 95% CI)

6.99 [1.55, 31.58]

5.1 Nervousness, insomnia, hyperactivity

2

154

Odds Ratio (M‐H, Fixed, 95% CI)

9.40 [1.16, 76.20]

5.2 Stomachache, nausea, and vomiting

1

74

Odds Ratio (M‐H, Fixed, 95% CI)

5.90 [0.27, 127.14]

5.3 Drowsiness

1

74

Odds Ratio (M‐H, Fixed, 95% CI)

3.43 [0.14, 87.09]

Figuras y tablas -
Comparison 3. Adverse events