In the JournalsPerspective

Physicians more likely to recommend antihistamines for respiratory infections in kids

Image of Tobias Gerhard
Tobias Gerhard

There has been a sharp decline since 2008 in recommendations for cough and cold medicines for respiratory infections in children, but an increase in recommendations for antihistamines, according to study results published in JAMA Pediatrics.

“In 2008, multiple groups, such as the FDA and the American Academy of Pediatrics, recommended against the use of cough and cold medicines (CCMs) in younger children,” Tobias Gerhard, PhD, BSPharm, associate professor of pharmacy and epidemiology at Rutgers University Ernest Mario School of Pharmacy, told Infectious Diseases in Children. “Our study found that doctors decreased their recommendations for certain types of cough and cold medicines for young children, particularly for those aged younger than 2 years and those receiving the more dangerous kinds containing opioids.”

The recommendations came at the cost of increased recommendations for other types of medicines — namely antihistamines, which have little benefit for children with colds, according to Gerhard.

Gerhard and colleagues studied data from the 2002 to 2015 from the United States-based National Ambulatory Medical Care Surveys and the National Hospital Ambulatory Medical Care Surveys. These surveys showed cross-sectional, visit-level data on demographics, diagnoses and medications provided or ordered at visits, including recommended over-the-counter medications. The study sample consisted of all visits for children aged younger than 18 years, the researchers wrote.

Of 3.1 billion pediatric visits over 14 years, U.S. physicians ordered approximately 95.7 million CCMs, of which 12% (sample n = 734 of 5,525; 95% CI, 10%-14.3%) contained opioids, according to the study. The researchers reported a substantial decline in recommendations for nonopioid and opioid-containing CCMs, whereas those for antihistamines rose. After 2008, the trend in nonopioid CCM recommendations declined 56% among children aged younger than 2 years and 68% among children aged younger than 6 years for opioid-containing CCMs, they wrote. The trend in antihistamine recommendations increased overall and was strongest in children aged younger than 12 years at 25%.

“The reason why the use of antihistamines increased could not be determined from our data,” Gerhard said. “One might guess, however, that some doctors started recommending antihistamines more often as a safer alternative to other cough and cold medicines, although colds in children do not generally need to be treated with medications.” – by Joe Gramigna

Disclosures: Gerhard reports previous consulting work for Eli Lilly. Please see the study for all other authors’ relevant financial disclosures.

Image of Tobias Gerhard
Tobias Gerhard

There has been a sharp decline since 2008 in recommendations for cough and cold medicines for respiratory infections in children, but an increase in recommendations for antihistamines, according to study results published in JAMA Pediatrics.

“In 2008, multiple groups, such as the FDA and the American Academy of Pediatrics, recommended against the use of cough and cold medicines (CCMs) in younger children,” Tobias Gerhard, PhD, BSPharm, associate professor of pharmacy and epidemiology at Rutgers University Ernest Mario School of Pharmacy, told Infectious Diseases in Children. “Our study found that doctors decreased their recommendations for certain types of cough and cold medicines for young children, particularly for those aged younger than 2 years and those receiving the more dangerous kinds containing opioids.”

The recommendations came at the cost of increased recommendations for other types of medicines — namely antihistamines, which have little benefit for children with colds, according to Gerhard.

Gerhard and colleagues studied data from the 2002 to 2015 from the United States-based National Ambulatory Medical Care Surveys and the National Hospital Ambulatory Medical Care Surveys. These surveys showed cross-sectional, visit-level data on demographics, diagnoses and medications provided or ordered at visits, including recommended over-the-counter medications. The study sample consisted of all visits for children aged younger than 18 years, the researchers wrote.

Of 3.1 billion pediatric visits over 14 years, U.S. physicians ordered approximately 95.7 million CCMs, of which 12% (sample n = 734 of 5,525; 95% CI, 10%-14.3%) contained opioids, according to the study. The researchers reported a substantial decline in recommendations for nonopioid and opioid-containing CCMs, whereas those for antihistamines rose. After 2008, the trend in nonopioid CCM recommendations declined 56% among children aged younger than 2 years and 68% among children aged younger than 6 years for opioid-containing CCMs, they wrote. The trend in antihistamine recommendations increased overall and was strongest in children aged younger than 12 years at 25%.

“The reason why the use of antihistamines increased could not be determined from our data,” Gerhard said. “One might guess, however, that some doctors started recommending antihistamines more often as a safer alternative to other cough and cold medicines, although colds in children do not generally need to be treated with medications.” – by Joe Gramigna

Disclosures: Gerhard reports previous consulting work for Eli Lilly. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Jennifer L. Goldman

    Jennifer L. Goldman

    This is an interesting study. It is well known in pediatrics over the past several years that guidelines have been set forth recommending against CCMs, especially in young children, given their lack of efficacy and potential risk. This study demonstrates that physicians' recommendations for CCMs in children have decreased over time, especially for opioid-containing cough and cold medicines. However, these medications are still being recommended in children aged younger than 6 years, despite the American Academy of Pediatrics' recommendations to avoid all CCMs in children in this age group.

    Young children are at highest risk for recurrent viral infections, which will often take 7 to 10 days to run their course. There are very little data supporting the use of any medications in these young children to effectively treat their symptoms. I think that is important for all physicians to keep in mind.

    I also found it interesting that the researchers did see an increased trend in the recommendations of antihistamines. This suggests that physicians may be replacing their recommendation for over-the-counter CCMs with a recommendation of off-label antihistamines. I think physicians should be aware that the data to support that recommendation in young children have not been well studied either.

    • Jennifer L. Goldman, MD, MS
    • Member, Infectious Diseases Society of America
      Associate professor of pediatrics
      University of Missouri-Kansas City School of Medicine
      Pediatric infectious disease specialist
      Children’s Mercy Kansas City