World Journal of Pediatrics

, Volume 13, Issue 1, pp 27–33 | Cite as

Efficacy and tolerability of a polysaccharide-resin-honey based cough syrup as compared to carbocysteine syrup for children with colds: a randomized, single-blinded, multicenter study

  • Herman Avner Cohen
  • Moshe Hoshen
  • Shmuel Gur
  • Arie Bahir
  • Yoseph Laks
  • Hannah Blau
Original article



Available pediatric treatments for acute cough are limited by lack of demonstrated efficacy. The objective of this trial is to compare the effects of a polysaccharide-resin-honey based cough syrup, and carbocysteine syrups on nocturnal and daytime cough associated with childhood upper respiratory tract infections (URIs).


Using a single-blind randomization design, the study recruited children from 4 general pediatric community clinics. Participants included 150 children aged 2 to 5 years with an URI, nocturnal and daytime cough and illness duration of ≤7 days. To be eligible, children had to be free of medication on the day before presentation. A survey was administered to parents on 4 consecutive days beginning from the day of presentation in clinic. Children received the study preparation on the first evening and then 3 times per day for 3 further days. Main outcome measures were cough frequency, cough severity, bothersome nature of cough, and quality of sleep for both child and parent.


Both preparations were well tolerated and cough improved over the study period. After one night and on all survey days, there was a significantly better result for polysaccharide-resin-honey (P<0.05) for all the main outcome measures. The trend of improvement over the 4 days was steeper for polysaccharide-resin-honey (P<0.05) with regards to all cough parameters.


Both polysaccharide-resin-honey and carbocysteine cough syrups were well tolerated in children over 2 years of age. The polysaccharide-resin-honey syrup was associated with a more rapid and greater improvement in all clinical cough symptoms measured, beginning from the first night of therapy. Both nocturnal and daytime cough improved, as did sleep quality for both children and parents.

Key words

cough children upper respiratory tract infection 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kesson AM. Respiratory virus infections. Paediatr Respir Rev 2007;8:240–248.CrossRefPubMedGoogle Scholar
  2. 2.
    Gonzales R, Malone DC, Maselli JH, Sande MA. Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis 2001;33:757–762.CrossRefPubMedGoogle Scholar
  3. 3.
    Fendrick AM, Monto AS, Nightengale B, Sarnes M. The economic burden of non-influenza-related viral respiratory tract infection in the United States. Arch Intern Med 2003;163:487–494.CrossRefPubMedGoogle Scholar
  4. 4.
    De Blasio F, Dicpinigaitis PV, Rubin BK, De Danieli G, Lanata L, Zanasi A. An observational study on cough in children: epidemiology, impact on quality of sleep and treatment outcome. Cough 2012;8:1.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev 2012;8:CD001831.Google Scholar
  6. 6.
    Paul IM. Therapeutic options for acute cough due to upper respiratory infections in children. Lung 2012;190:41–44.CrossRefPubMedGoogle Scholar
  7. 7.
    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:e85–e90.CrossRefPubMedGoogle Scholar
  8. 8.
    Yoder KE, Shaffer ML, La Tournous SJ, Paul IM. Child assessment of dextromethorphan, diphenhydramine, and placebo for nocturnal cough due to upper respiratory infection. Clin Pediatr (Phila) 2006;45:633–640.CrossRefGoogle Scholar
  9. 9.
    Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med 2007;161:1140–1146.CrossRefPubMedGoogle Scholar
  10. 10.
    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;16:787–793.CrossRefPubMedGoogle Scholar
  11. 11.
    Cohen HA, Rozen J, Kristal H, Laks Y, Berkovitch M, Uziel Y, et al. Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study. Pediatrics 2012;130:465–471.CrossRefPubMedGoogle Scholar
  12. 12.
    Canciani M, Murgia V, Caimmi D, Anapurapu S, Licari A, Marseglia GL. Efficacy of Grintuss® pediatric syrup in treating cough in children: a randomized, multicenter, double-blind, placebo-controlled clinical study. Ital J Pediatr 2014;40:56.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Mallet P, Mourdi N, Dubus JC, Bavoux F, Boyer-Gervoise MJ, Jean-Pastor MJ, et al. Respiratory paradoxical adverse drug reactions associated with acetylcysteine and carbocysteine systemic use in paediatric patients: a national survey. PloS One 2011;6:e22792.CrossRefGoogle Scholar
  14. 14.
    Chalumeau M, Duijvestijn YC. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic-pulmonary disease. Cochrane Database Syst Rev 2013;5:CD003124.Google Scholar
  15. 15.
    Footitt J, Johnston SL. Cough and viruses in airway disease: mechanisms. Pulm Pharmacol Ther 2009;22:108–113.CrossRefPubMedGoogle Scholar
  16. 16.
    Dicpinigaitis PV. Effect of viral upper respiratory tract infection on cough reflex sensitivity. J Thorac Dis 2014;6:S708–S711.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Morice AH. The cough hypersensitivity syndrome: a novel paradigm for understanding cough. Lung 2010;188:S87–S90.CrossRefPubMedGoogle Scholar
  18. 18.
    Morice AH, McGarvey LP, Dicpinigaitis PV. Cough hypersensitivity syndrome is an important clinical concept: a pro/con debate. Lung 2012;190:3–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Davenport PW. Urge-to-cough: what can it teach us about cough? Lung 2008;186:S107–S111.CrossRefPubMedGoogle Scholar
  20. 20.
    Dicpinigaitis PV, Bhat R, Rhoton WA, Tibb AS, Negassa A. Effect of viral upper respiratory tract infection on the urge-tocough sensation. Respir Med 2011;105:615–618.CrossRefPubMedGoogle Scholar
  21. 21.
    Wegener T, Kraft K. Plantain (Plantago lanceolata L.): antiinflammatory action in upper respiratory tract infections. Wien Med Wochenschr 1999;149:211–216.[In German]PubMedGoogle Scholar
  22. 22.
    Franz G. Polysaccharides in pharmacy: current applications and future concepts. Planta Med 1989;55:493–497.CrossRefPubMedGoogle Scholar
  23. 23.
    Nosalova G, Fleskova D, Jurecek L, Sadlonova V, Ray B. Herbal polysaccharides and cough reflex. Respir Physiol Neurobiol 2013;187:47–51.CrossRefPubMedGoogle Scholar
  24. 24.
    Israili ZH. Antimicrobial properties of honey. Am J Ther 2014;21:304–323.CrossRefPubMedGoogle Scholar
  25. 25.
    White JW. Composition of honey. In: Crabe E, eds. Honey: A comprehensive survey. New York, NY: Crane, Russak Company, 1975: 157–206.Google Scholar
  26. 26.
    Gheldof N, Engeseth NJ. Antioxidant capacity of honeys from various floral sources based on the determination of oxygen radical absorbance capacity and inhibition of in vitro lipoprotein oxidation in human serum samples. J Agric Food Chem 2002;50:3050–3055.CrossRefPubMedGoogle Scholar
  27. 27.
    Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Cochrane in context: Honey for acute cough in children. Evid Based Child Health 2014;9:401–444.CrossRefPubMedGoogle Scholar
  28. 28.
    Warren MD, Pont SJ, Barkin SL, Callahan ST, Caples TL, Carroll KN, et al. The effect of honey on nocturnal cough and sleep quality for children and their parents. Arch Pediatr Adolesc Med 2007;161:1149–1153.CrossRefPubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Herman Avner Cohen
    • 1
    • 2
    • 8
  • Moshe Hoshen
    • 3
  • Shmuel Gur
    • 2
    • 4
  • Arie Bahir
    • 2
    • 5
  • Yoseph Laks
    • 2
    • 6
  • Hannah Blau
    • 2
    • 7
  1. 1.YehudIsrael
  2. 2.Sackler Faculty of MedicineTel-Aviv UniversityTel-AvivIsrael
  3. 3.Clalit Research Institute, Chief Physician’s OfficeClalit Health ServicesTel AvivIsrael
  4. 4.Pediatric Ambulatory Community ClinicKefar SabaIsrael
  5. 5.Pediatric Ambulatory Community ClinicBat YamIsrael
  6. 6.Pediatric Ambulatory Community ClinicRamat AvivIsrael
  7. 7.Pulmonary InstituteSchneider Children Medical Center of IsraelPetah TikvaIsrael
  8. 8.Pediatric Ambulatory Community ClinicPetah-TikvaIsrael

Personalised recommendations