PEDIATRICS Vol. 115 No. 2 February 2005, pp. 512-513 (doi:10.1542/peds.2004-2460)
Effect of Dextromethorphan, Diphenhydramine, and Placebo on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents: In Reply
Ian M. Paul, MD, MScPennsylvania State Children's Hospital
Milton S. Hershey Medical Center
Hershey, PA 17033-0850
We appreciate the opportunity to have additional dialogue regarding over-the-counter (OTC) cough medications and our recent publication.1 Dr Skoner's letter highlights several concerns that have been raised regarding the use of these medications. Unfortunately, most of these issues are due to the lack of data and publications surrounding these medications in the setting of acute cough in children and a lack of safe therapeutic alternatives.
The American Academy of Pediatrics (AAP) does not endorse the use of these medications for the treatment of acute cough caused by an upper respiratory infection (URI),2 nor do evidence-based reviews of the literature.3–5 In agreement with the AAP policy statement, we do not find data in the medical literature to support a therapeutic benefit in children.
It is noted that our study used a subjective scoring system to determine outcomes. This highlights the lack of attention that has been paid to the common symptom of acute cough in children and therapeutic interventions for it, because to our knowledge, no validated tool for this purpose is currently in existence. Therefore, as clinicians, we designed the survey to represent questions that are commonly asked of parents of children with these symptoms in clinical practice. The Likert scale is also similar to other related studies in this setting and those used in studies of cough in children with conditions such as asthma.6–9 We acknowledge the potential benefits of objective cough monitoring but find no studies in the medical literature describing objective monitoring of the effects of dextromethorphan or diphenhydramine as single agents for children with cough caused by URI.
Dr Skoner also notes that by 4 days, many URIs may be resolving already. We did conduct an analysis (unpublished data) of the data to determine if the medications were more effective in patients that presented earlier in the illness with those presenting later in the illness and were unable to detect any differences. In this analysis, "days ill" was treated as both a continuous and categorical variable.
Again, we appreciate the opportunity for continued dialogue related to OTC cough medications. Although Dr Skoner believes that we have overstated the lack of benefit of these drugs in our article, we believe otherwise and will again restate our conclusion that the study raises "questions [of] whether common OTC medications have a place in the treatment of these illnesses for children." We look forward to continued investigation of these medications and a safe and effective treatment for acute cough caused by URI.
REFERENCES
- Paul IM, Yoder KE, Crowell KR, et al. Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics. 2004;114 (1). Available at: www.pediatrics.org/cgi/content/full/114/1/e85
- American Academy of Pediatrics, Committee on Drugs. Use of codeine- and dextromethorphan-containing cough remedies in children.
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[Abstract/Free Full Text] - Korppi M, Laurikainen K, Pietikainen M, Silvasti M. Antitussives in the treatment of acute transient cough in children. Acta Paediatr Scand. 1991;80 :969 –971[Web of Science][Medline]
- Taylor JA, Novack AH, Almquist JR, Rogers JE. Efficacy of cough suppressants in children. J Pediatr. 1993;122 :799 –802[Web of Science][Medline]
- Chang AB, Newman RG, Carlin JB, Phelan PD, Robertson CF. Subjective scoring of cough in children: parent-completed vs child-completed diary cards vs an objective method. Eur Respir J. 1998;11 :462 –466[Abstract]
- Hsu JY, Stone RA, Logan-Sinclair RB, Worsdell M, Busst CM, Chung KF. Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder. Eur Respir J. 1994;7 :1246 –1253[Abstract]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
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Related articles in Pediatrics:
- Effect of Dextromethorphan, Diphenhydramine, and Placebo on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents
- David P. Skoner
Pediatrics 2005 115: 512.[Extract] [Full Text]
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