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June 2004
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February 2004
As many of you know, this has been a winter filled with lots of illness. Simple measures to keep your children well include frequent hand-washing and changing clothing upon arrival home from school to prevent others in the household from getting ill. As of February 1st only 49 days until spring. I wonder what the groundhog will tell us. FYI this is a leap year.
Dr. Barenfeld
Considerations for the Choice of Cough-Cold Medication (CCM) Product Selection-------------
Echinacea Study----------
To reiterate, there is no cure for the common cold. As all of you know, conventional treatments such as decongestants, antihistamines and cough suppressants offer only modest benefit for symptom relief. Because of this many people turn to alternative therapies.
Echinacea accounts for nearly $300 million in sales each year despite a lack of definitive evidence on its safety or efficacy. A recent study on 407 children aged 2 – 11 years was done with Echinacea. Study results showed no difference in duration of cold symptoms, peak severity of cold symptoms, number of days of peak symptoms, number of days of fever or in parent assessment of the severity of the cold, compared to those children not taking Echinacea. Researchers did note that children taking Echinacea had fewer subsequent upper respiratory infections, however, the difference was not statistically significant and therefore warrants further investigation. There were no significant side effects seen in the study. There have been no studies to date looking at long term side effects from Echinacea either in children or adults.
One of the most frequent topics of conversation in our practice involves questions about cough and cold medications. Young children average about 10 colds per year for which there is no cure. This prompts us to select one of the dozens of products available at the pharmacist that provide symptom relief for our suffering children. Hopefully, this brief summary will answer many of the questions that you have and will help you choose the best product for your child.
Product effectiveness
- There are no published studies showing evidence for CCM product effectiveness and safety in infants and young children. Children less than 6 months of age should not use any of these products.
- There is some evidence for CCM ingredient effectiveness in adolescents. Studies have shown that:
- antihistamines may reduce some cold symptoms.
- decongestants may reduce symptoms of nasal congestion.
- Antihistamines may cause sedation.
Multi-ingredient products
- Numerous multi-ingredient products are available which may confuse caregivers.
- Multi-ingredient products increase the risk of side effects.
- Single ingredient products will best target the patient’s most bothersome symptom.
- Nearly all CCM ingredients are available as single-ingredient products.
- Examples:
- Dextromethorphan (Robitussin Pediatric Cough Syrup)
- Pseudoephedrine (Sudafed Nasal Decongestant)
- Chlorpheniramine (Chlor-Trimeton) an antihistfumine
Analgesics (Fever and discomfort)
- CCM may contain acetaminophen (Tylenol) or ibuprofen (Motrin) that the caregiver may not be aware of. This may cause an overdose when additional doses of Tylenol or Motrin are given for fever.
Adverse effects
- Numerous significant adverse effects are possible with CCM.
- Risk increases in younger age, and use of multi-ingredient products.
- Sedation from antihistamines may be problematic for children (school drowsiness ) and adolescents/adults (while driving).
- Decongestants may result in hyperactivity and prevent sleep or cause increased congestion (especially nasal sprays).
Caregiver education
- Use single-ingredient products vs. multi-ingredient products when possible.
- Alternative therapy that is effective and safer, especially for infants and younger children (nasal saline drops, bulb syringe suctioning, and humidifier).
- Always use the proper dose and ask us if not listed on the product label.
- Use caution with products containing analgesics to avoid excessive dosing.
Mind Bender of the Month------------------------------------------
Knights Dice Maze
Starting from the bottom middle square (#1 - green), move from dice to dice in the repeated sequence 1-2-3-4-5 by jumping like a knight in chess (two along and one sideways) and end on the middle (#5 - red) square.
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