Acute Respiratory Infection

Tobias Gerhard, BSPharm, PhD, on Trends in Cold Medicine Recommendation in Children

A recent study showed that while recommendations for cough and cold medicines in young children with acute respiratory infections have decreased in recent years, rates of recommendations for antihistamines have increased over the same time.

Consultant360 spoke with Tobias Gerhard, BSPharm, PhD, Associate Professor of Pharmacy and Epidemiology and Director of the Center for Pharmacoepidemiology and Treatment Science at Rutgers University about the study findings and what they mean for clinical practice.

Consultant360: Can you give us some background on why your research was conducted?

Tobias Gerhard: In 2008, several professional groups made recommendations against the use of cough and cold medicines in young children: the US Food and Drug Administration, for children younger than age 2; cough and cold medicine manufacturers, for children younger than age 4; and the American Academy of Pediatrics, for children younger than age 6. We were interested in studing how trends of physicians' recommendations of cough and cold medicines for children changed after these recommendations for different age groups and different kinds of medicines, including cough and cold medicines with and without opioids as well as single-agent antihistamines. 

Consultant360: What were the key takeaways of your research and how will your findings impact clinical practice?

TG: After 2008, physicians appeared to respond to professional warnings against use of cough and cold medicines in young children, particularly in children under age 2 and children under age 6 taking opioid-containing cough and cold medicines. However, recommendations for antihistamines rose at the same time, suggesting a replacement with medicines that do not tend to work well for colds.

Generally, colds in children do not need to be treated with medications; they will get better on their own. They can be managed at home with fluids, rest, medicines for fever or pain such as acetaminophen or ibuprofen, honey for cough (safe only for children over 1), and tincture of time. Children should see their doctors if they are not able to keep up with fluids, appear dehydrated or lethargic, have difficulty breathing, have fevers that persist for several days, or if there are other concerns. 

Consultant360: What knowledge gaps still exist in this area?

TG: Future research should examine whether the observed trends have continued more recently and how changing utilization of cough and cold medicines has influenced outcomes in children.



Horton DB, Gerhard T, Strom BL. Trends in cough and cold medicine recommendations for children in the United States, 2002-2015 [published online July 29, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.2252.