Medications and non-pharmacological measures to alleviate the symptoms of respiratory tract infections in the pediatric population

  • Maja Tomić University of Belgrade – Faculty of Pharmacy, Department of Pharmacology
  • Uroš Pecikoza University in Belgrade – Faculty of Pharmacy, Department of Pharmacology
Keywords: respiratory tract infections, medications, non-pharmacological measures, pediatric population

Abstract


In the pediatric population, acute respiratory tract infections (RTIs) are the most common reason for seeking professional help from a physician or a pharmacist. Alleviation of symptoms is the only therapeutic measure in viral RTIs and is an adjunct to antibiotic therapy in bacterial RTIs. This article discusses pharmacologic and non-pharmacologic options for treating nasal congestion, cough, fever and sore throat in RTIs and clinical evidence on their efficacy and safety in the pediatric population. In general, clinical studies conducted in children for most of these drug groups are few or nonexistent, making it difficult to create evidence-based recommendations. Nasal decongestants, cough suppressants, mucolytics, expectorants, antipyretics/analgesics and sore throat local preparations are available in suitable pharmaceutical forms and strengths for the certain age. As many of them are over-the-counter (OTC) preparations, it is necessary to strictly take into account the age of the child in whom they may be used and dose properly. Multicomponent preparations carry the risk of taking unnecessary medications and of their side effects. The use of multiple OTC medicines is associated with the risk of an overdose of a component that may be present in different preparations. Appropriate non-pharmacological measures (e.g. oral hydration, nasal saline application or irrigation, honey) may be helpful and should be used whenever possible due to their safety.

References

Benavides S, Nahata MC, editors. Pediatric Pharmacotherapy. 1st ed. Lenexa: American college of Clinical Pharmacy; 2013.

Kliegman RM, Stanton BMD, St. Geme J, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics. 20th ed. Amsterdam: Elsevier Health Sciences; 2016.

Rubin MA, Ford LC, Gonzales R. Sore Throat, Earache, and Upper Respiratory Symptoms. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison's Principles of Internal Medicine. 20th ed. New York: McGraw-Hill Companies; 2018; p. 208-18.

Tomić M. Farmakoterapija faringitisa, sinuzitisa i otitis media. Arh. Farm. 2011;61(2):165-76.

Cough and cold remedies for the treatment of acute respiratory infections in young children [Internet]. World Health Organization; 2001 [cited 2022 May 25]. Available from: https://apps.who.int/iris/handle/10665/66856.

Short S, Bashir H, Marshall P, Miller N, Olmschenk D, Prigge K, et al. Diagnosis and Treatment of Respiratory Illness in Children and Adults [Internet]. Institute for Clinical Systems Improvement; 2017 [updated September 2017; cited 2022 May 25]. Available from: https://www.icsi.org/wp-content/uploads/2019/01/RespIllness.pdf.

British National Formulary (BNF) for Children 2021-2022. London: BMJ Group and Pharmaceutical Press, 2021.

Šlapak I, Skoupá J, Strnad P, Horník P. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg. 2008;134(1):67-74.

Chirico G, Quartarone G, Mallefet P. Nasal congestion in infants and children: a literature review on efficacy and safety of non-pharmacological treatments. Minerva Pediatr. 2014;66(6):549-57.

Singh M, Singh M, Jaiswal N, Chauhan A. Heated, humidified air for the common cold. Cochrane Database Syst Rev. 2017;8(8):CD001728.

Kenia P, Houghton T, Beardsmore C. Does inhaling menthol affect nasal patency or cough? Pediatr Pulmonol. 2008;43(6):532-7.

Paul IM, Beiler JS, King TS, Clapp ER, Vallati J. Vapor rub, petrolatum, and no treatment for children with nocturnal cough and cold symptoms. Pediatrics. 2010;126(6):1092-99.

Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev. 2016;10(10):CD009612.

Söderman P, Sahlberg D, Wiholm BE. CNS reactions to nose drops in small children. Lancet. 1984;1(8376):573.

Electronic Medicines Compendium (eMC) [Internet]. Datapharm Ltd; c2022 [cited 2022 May 25]. Available from: https://www.medicines.org.uk/emc/.

Mediately Baza lekova [Internet]. MODRA JAGODA, spletno oblikovanje in razvoj mobilnih aplikacij d.o.o; c2022 [cited 2022 May 25]. Available from: https://mediately.co/rs/drugs.

Brayfield A, editor. Martindale: The Complete Drug Reference. 39th edition. London: Pharmaceutical Press; 2017.

Westfall TC, Macarthur H, Westfall DP. Adrenergic Agonists and Antagonists. In: Brunton LL, Hilal-Dandan R, Knollmann BC, editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 13th ed. New York: McGraw-Hill Education; 2018; p. 191-223.

Gelotte CK, Albrecht HH, Hynson J, Gallagher V. A Multicenter, Randomized, Placebo-Controlled Study of Pseudoephedrine for the Temporary Relief of Nasal Congestion in Children With the Common Cold. J Clin Pharmacol. 2019;59(12):1573-83.

Marseglia GL, Manti S, Chiappini E, Brambilla I, Caffarelli C, Calvani M, et al. Acute cough in children and adolescents: A systematic review and a practical algorithm by the Italian Society of Pediatric Allergy and Immunology. Allergol Immunopathol (Madr). 2021;49(2):155-69.

Oduwole O, Udoh EE, Oyo-Ita A, Meremikwu MM. Honey for acute cough in children. Cochrane Database Syst Rev. 2018;4(4):CD007094.

Ahmadi M, Moosavi SM, Zakeri S. Comparison of the effect of honey and diphenhydramine on cough alleviation in 2-5 year-old children with viral upper respiratory tract infection. J Gorgan Univ Med Sci. 2013;15(2):8-13.

Cohen HE, Rozen J, Kristal H, Laks Y, Berkovitch M, Uziel Y, et al. Effect of honey on nocturnal cough and sleep quality: a double-blind, randomised, placebo-controlled study. Pediatrics. 2012;130(3):465-71.

Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM Jr. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-6.

Peixoto DM, Rizzo JA, Schor D, Silva AR, Cavalcanti de Oliveira D, Solé D, et al. Use of honey associated with Ananas comosus (Bromelin) in the treatment of acute irritative cough [Uso do mel de abelha associado ao Ananas comosus (Bromelin) no tratamentoda tosse irritativa aguda]. Revista Paulista de Pediatria. 2016;34(4):412-7. (in Portuguese).

Shadkam MN, Mozaffari-Khosravi H, Mozayan MR. A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents. J Altern Complement Med. 2010;16(7): 787-93.

Waris A, Macharia WM, Njeru EK, Essajee F. Randomised double blind study to compare effectiveness of honey, salbutamol and placebo in treatment of cough in children with common cold. East Afr Med J. 2014;91(2):50-6.

Barnes PJ. Pulmonary Pharmacology. In: Brunton LL, Hilal-Dandan R, Knollmann BC, editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 13th ed. New York: McGraw-Hill Education; 2018; p. 727-49.

Dicpinigaitis PV, Morice AH, Birring SS, McGarvey L, Smith JA, Canning BJ, et al. Antitussive drugs - past, present, and future. Pharmacol Rev. 2014;66(2):468-512.

Taylor JA, Novack AH, Almquist JR, Rogers JE. Efficacy of cough suppressants in children. J Pediatr. 1993;122(5 Pt 1):799-802.

Bhattacharya M, Joshi N, Yadav S. To compare the effect of dextromethorphan, promethazine and placebo on nocturnal cough in children aged 1-12 y with upper respiratory infections: a randomized controlled trial. Indian J Pediatr. 2013;80(11):891-5.

Korppi M, Laurikainen K, Pietikaenen M, Silvasti M. Antitussives in the treatment of acute transient cough in children. Acta Paediatr Scand. 1991;80:969-71.

Paul IM, Yoder KE, Crowell KR, Shaffer ML, McMillan HS, Carlson LC, et al. Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics. 2004;114(1):e85-90.

Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev. 2014;2014(11):CD001831.

British National Formulary (BNF), Number 81. London: BMJ Group and Pharmaceutical Press, 2021.

Lam SHF, Homme J, Avarello J, Heins A, Pauze D, Mace S, et al. Use of antitussive medications in acute cough in young children. J Am Coll Emerg Physicians Open. 2021;2(3):e12467.

Płusa T. Miejsce cytrynianu butamiratu w kontrolowaniu kaszlu w zapaleniu dróg oddechowych [Butamirate citrate in control of cough in respiratory tract inflammation]. Pol Merkur Lekarski. 2017;43(254):69-74. (in Polish).

Zanasi A, Lanata L, Fontana G, Saibene F, Dicpinigaitis P, De Blasio F. Levodropropizine for treating cough in adult and children: a meta-analysis of published studies. Multidiscip Respir Med. 2015;10(1):19.

Kim DS, Sohn MH, Jang GC. Levodropropizine in children with bronchitis. Diagn Treat. 2002;22:9.

De Blasio F, Dicpinigaitis PV, Rubin BK, De Danieli G, Lanata L, Zanasi A. An observational study on cough in children: epidemiology, impact on the quality of sleep and treatment outcome. Cough. 2012;8(1):1.

Zanasi A, Lanata L, Saibene F, Fontana G, Dicpinigaitis PV, Venier V, et al. Prospective study of the efficacy of antibiotics versus antitussive drugs for the management of URTI-related acute cough in children. Multidiscip Respir Med. 2016;11:29.

Sakchainanont B, Ruangkanchanasetr S, Chantarojanasiri T, Tapasart C, Suwanjutha S. Effectiveness of antihistamines in common cold. J Med Assoc Thai. 1990;73(2):96-101.

Nespoli L, Monafo V, Bonetti F, Terracciano L, Savio G. Clinical evaluation of letosteine activity in the treatment of acute febrile bronchitis in pediatric age. Controlled double-blind vs placebo investigation. Minerva Pediatrica. 1989;41(10):515-20.

Malerba M, Ragnoli B. Ambroxol in the 21st century: pharmacological and clinical update. Expert Opin Drug Metab Toxicol. 2008;4(8):1119-29.

Principi N, Zavattini G, Daniotti S. Possibility of interaction among antibiotics and mucolytics in children. Int J Clin Pharmacol Res. 1986;6(5):369-72.

Dinarello CA, Porat R. Fever. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison's Principles of Internal Medicine. 20th ed. New York: McGraw-Hill Companies; 2018; p. 102-5.

Section on Clinical Pharmacology and Therapeutics; Committee on Drugs, Sullivan JE, Farrar HC. Fever and antipyretic use in children. Pediatrics. 2011;127(3):580-7.

Tomić M, Micov A, Pecikoza U, Stepanović-Petrović R. Chapter 1 - Clinical Uses of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Potential Benefits of NSAIDs Modified-Release Preparations. In: Čalija B, editor. Microsized and Nanosized Carriers for Nonsteroidal Anti-Inflammatory Drugs. Cambridge: Academic Press; 2017; p. 1-29.

Grosser T, Smyth EM, FitzGerald GA. Pharmacotherapy of Inflammation, Fever, Pain, and Gout. In: Brunton LL, Hilal-Dandan R, Knollmann BC, editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 13th ed. New York: McGraw-Hill Education; 2018; p. 685-709.

Tan E, Braithwaite I, McKinlay CJD, Dalziel SR. Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(10):e2022398.

Wong T, Stang AS, Ganshorn H, Hartling L, Maconochie IK, Thomsen AM, et al. Combined and alternating paracetamol and ibuprofen therapy for febrile children. Cochrane Database Syst Rev. 2013;2013(10):CD009572.

Fever in under 5s: assessment and initial management [Internet]. National Institute of Clinical Excellence; c2021 [cited 2022 May 25]. Available from: https://www.nice.org.uk/guidance/ng143/chapter/Recommendations#antipyretic-interventions.

Lesko SM, Mitchell AA. An assessment of the safety of pediatric ibuprofen. A practitioner-based randomized clinical trial. JAMA. 1995;273(12):929-33.

Kanabar DJ. A clinical and safety review of paracetamol and ibuprofen in children. Inflammopharmacology. 2017;25(1):1-9.

de Looze F, Shephard A, Smith AB. Locally Delivered Flurbiprofen 8.75 mg for Treatment and Prevention of Sore Throat: A Narrative Review of Clinical Studies. J Pain Res. 2019;12:3477-509.

Wethington JF. Double-blind study of benzydamine hydrochloride, a new treatment for sore throat. Clin Ther. 1985;7(5):641-6.

Schønemann NK, van der Burght M, Arendt-Nielsen L, Bjerring P. Onset and duration of hypoalgesia of lidocaine spray applied to oral mucosa--a dose response study. Acta Anaesthesiol Scand. 1992;36(7):733-5.

de Mey C, Koelsch S, Richter E, Pohlmann T, Sousa R. Efficacy and Safety of Ambroxol Lozenges in the Treatment of Acute Uncomplicated Sore Throat - a Pooled Analysis. Drug Res (Stuttg). 2016;66(7):384-92.

Over-the-counter cough and cold medicines for children - Advice on how to use cough and cold medicines safely for children under 12 years [Internet]. Medicines and Healthcare products Regulatory Agency; c2014 [cited 2022 May 25]. Available from: https://www.gov.uk/drug-safety-update/over-the-counter-cough-and-cold-medicines-for-children.

Published
2022/06/29
Section
Review articles