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The poison in cough and cold syrups

WEDNESDAY LIFE
By Achieng Ivisu | March 2nd 2016

On February 9, 2016, a young mother took to her facebook wall to share her three month frustration trying to help her child recover from a cold.

“I have just come from taking my two-year-old to see a chest specialist and I must share what I have learned about cough syrups,” she said.

She then went on to detail her experience at the hands of general pediatricians who prescribed the same medication even thought it was clearly not working. And that she learned some of the medicine on our shelves is actually banned in some countries.

“I write this because I am pissed at the system and these bogus doctors who care more about money than the child they are treating. So to all mums out there, do your research on drugs. Knowledge is power,” she advised.

Intrigued by her detailed account, we set out to seek expert opinion in helping us determine whether or not there is some truth in what she had shared and whether or not this was just a one off occurrence.

Speaking to Dr Adil Waris, we learned it is an established truth in the field of science that no drug therapy can cure or shorten the duration of upper respiratory track infections such as coughs and colds

Dr Waris, who has been a paediatrician pulmonologist for 11 years and lecturer at the Aga Khan University and the University of Nairobi for the last nine years, further observed that some drugs in the market claiming to offer such relief actually do cause more harm than good.

Turning to research, a 2008 United States Food and Drug Authority (FDA) report recommended against over-the-counter sale of cough and cold medicines to children under the age two years.

The FDA, had established that these medicines only treated symptoms of coughs and colds but not the underlying condition, and as such had no proven effectiveness in infants and children that age. Most alarming were the many reports of harm, and even death, to children who used these products.

“These reports of harm occurred when the child received too much medication such as in cases as accidental ingestion, unintentional overdose, or after a medication dosing error. In those reports of harm that lead to a child’s death, most of those children were under two years of age.” The FDA report said.

In Canada, the Government’s health department responsible for public health said between January 1995 and May 2008, it had received 164 reports of adverse reactions in children under 12 related to cough and cold products. Of these, 105 were considered serious, including five deaths in children under the age of two - the youngest being four weeks old, the oldest 20 months.

In the US, Centres for Disease Control and Prevention (CDC) identified more than 1,500 emergency room visits between 2004 and 2005 for children under two who had been given cough or cold products. These children had suffered complications linking decongestants to ardiovascular events, antihistamines to hallucinations, and antitussives to depressed levels of consciousness and brain damage.

Back home, in 2010, the Kenya Paediatric Association and The Kenya Association for the Prevention of Tuberculosis and Lung Diseases each released consensus statements, after deliberations, saying that cold medicines were not safe for use.The Allergies Society of Kenya also discouraged use of these medicines for children with allergies and are asthmatic or have bronchitis.

Their statements were based on a research carried out at The Aga Khan University Hospital by, Dr Waris which affirmed that cough and cold medicines do not work in children.

Consequently, The Aga Khan University hospital made a policy decision to remove all cough and cold medications from their pharmacies. The only other hospital that does not stock these medicines is Kenyatta National Hospital.

According to Dr Waris, the greatest problem with these cough syrups is their history.

“Cough mixtures were made in the 1960’s and 1970’s when if I wanted to know whether this medicine could work, I would test it on one or two animals. Medical technology has since evolved. Today, I have to do a placebo controlled trial on humans before the drug is approved."

"I have to get patients with the condition I want to treat, and administer the real medicine to one half of the group and an inactive medicine like a sugar pill that looks like the same thing as the real drug, to the other half of the group. Thereafter, I will check the results of those testing the real drug against those taking the inactive drug to find out whether the drug actually works. Unfortunately, cough and cold medicines as well as antihistamines came in before this type of testing existed,” he said.

Despite the overwhelming information about the danger of these drugs pose, they remain on the shelves of Kenyan hospitals and pharmacies. Worse still these products continue to be prescribed by most Kenyan doctors despite their obvious professional knowledge of the side effects of the components in these drugs.

“They continue to practice a line of medicine that is not advocated for, approved or taught in any medical school or appears in any text book of paediatrics,” Dr Waris said.

The culpability of these doctors does not stop there, he narrated how in 2010 when the issue was made public, the average duty doctor would substitute the cough mixture with an antihistamine. Knowing full well that antihistamines do not work.

“Antihistamines only dry up the nose but does nothing to clear the chest. In fact, there is no research that shows antihistamine reducing the cough symptoms at all. Also, some of these drugs that the doctors would prescribe contain between four and 15 per cent harmful agents with other combining these harmful agents making our children twice at risk,” he said.

Although The Pharmacy and Poisons Board is fully aware of the dangers of these drugs, going by their online advisory to parents concerning over the counter purchase of children’s cough and cold medicines, they continue to allow these medicines to be part of pharmacy supplies.

Further, their directive to prohibit the sale of this drugs without a doctor’s prescription is counterproductive since there is no clear safeguard that stops pharmacists from selling these drugs.

So, what is a parent to do when their child gets a cold? Dr Waris recommends age old honey and frequent use of saline drops that helps the nose passage moisten and avoid stuffiness.

For a child below the age of one, parents are encouraged to use saline drops as frequently as possible. Dr Waris says this will lessen post nasal dripping and reduce the risk of worsening an existing cough.

For children between one and five years an additional 5ml of honey three times a day is advised, while 10 ml is recommended for children between the ages of five to ten years. The effectiveness of honey is well documented by the World Health Organisation which identifies it as a potential treatment that relieves irritation and inflammation.

The FDA also recommends use of a cool mist humidifier which helps nasal passages shrink and allows easier breathing. Warm mist humidifiers are not advisable since they can cause nasal passages to swell and make breathing more difficult.

Nasal suctioning with a bulb syringe or aspirator with or without saline nose drops, also works especially well for infants less than a year old. With children further encouraged to drink plenty of liquids as it will helps the child stay well hydrated.

Dr Waris also recommends paracetamol for the pain and fever experienced by the child while having a cough or cold.

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