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Over-the-Counter Cough Medicines Are Unproved

This systematic review found little evidence for or against the effectiveness of over-the-counter cough medicines.

Over-the-counter (OTC) cough medicines are commonly used, but their efficacy is uncertain. These British authors conducted a systematic review to assess the effectiveness of OTC medications for adults that purport to reduce cough caused by upper respiratory tract infections.

From a comprehensive database of 328 studies of acute respiratory infections, researchers sought randomized, controlled trials that compared cough reduction between oral OTC medications and placebo in ambulatory adults with acute cough. Fifteen trials involving 2166 patients met the criteria. There were only a small number of studies (range, 1-5) for each of 6 categories: cough suppressants (antitussives), expectorants, mucolytics, antihistamines, antihistamine-decongestant combinations, and other drug combinations. In 9 trials, active treatment was no more effective than placebo was. The results of the remaining 6 trials were of marginal clinical significance.

Comment: The number of randomized, controlled studies is small, their methodological quality is questionable, and several were supported by pharmaceutical companies. Although OTC cough medications are generally well tolerated, there is little evidence for or against their effectiveness, and they cannot be recommended to patients as a treatment for acute cough.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine May 15, 2002

Citation(s):

Schroeder K and Fahey T. Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults. BMJ 2002 Feb 9; 324:329-31.

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