After investigating the deaths of three infants between 1 and 6 months of age linked to cough and cold medication use, officials with the U.S. Centers for Disease Control and Prevention are emphasizing that these drugs should be used only after talking with a physician.

Between 2004 and 2005, approximately 1,500 children younger than 2 years old were treated in U.S. emergency departments for adverse events associated with cough and cold medications, Dr. A. Srinivasan and colleagues at the CDC note in the January 12th issue of the Morbidity and Mortality Weekly Report

For each of the three dead infants, a medical examiner or coroner determined that the cough and cold medications were the underlying causes of death.

Blood levels of the decongestant pseudoephedrine at autopsy ranged from 4700 to 7100 ng/mL, compared with blood levels of 180 to 500 ng/mL normally expected after therapeutic dosing in children between 2 to 12 years old.

Because of the risk of toxicity, the lack of dosing instructions, and the scarcity of published evidence on effectiveness of these medications in children younger than 2 years old, the authors advise that “parents and other caregivers should not administer cough and cold medications to children in this age group without first consulting a health-care provider and should follow the provider’s instructions precisely.”

In an editorial note, the CDC adds that the results of controlled trials indicate cough and cold medications are no more effective than placebo in children younger than 2 years of age.

Furthermore, the American College of Chest Physicians in 2006 released clinical practice guidelines for management of cough, advising clinicians to refrain from recommending cough suppressants for this age group.

Safer and probably more effective treatments for young patients’ symptoms include softening nasal secretions with saline nose drops or a cool-mist humidifier, then clearing nasal congestion with a rubber suction bulb.

SOURCE: Morbidity and Mortality Weekly Report, January 12, 2007.