A prospective, multicenter, observational study showed that 30% of children younger than two who had bronchiolitis were given the drugs, Katherine O'Donnell, M.D., of Children's Hospital Boston, reported at the Society for Academic Emergency Medicine meeting here.
The study, performed as part of the Multicenter Airway Research Collaboration of the Emergency Medicine Network, took place over the span of two bronchiolitis seasons from 2004 to 2006.
Last year, drug companies withdrew OTC cough and cold medications targeted to children younger than two and, shortly after, the FDA determined that they were ineffective and possibly dangerous (See: Drug Companies Voluntarily Withdraw Cough and Cold Medicines for Babies and PODCAST: FDA Panel Agrees Pediatric Cough and Cold Remedies 'Ineffective').
"After the recall and labeling changes," she said, "it will be important to monitor for potential ongoing use of these medicines in young children and observe if parents or physicians are turning to other therapies in place of these medications."
She said that physicians should discuss the ineffectiveness and potential harm of over-the-counter cough and cold medicines with parents of small children.
Dr. O'Donnell's group set out to describe the frequency and predictors of the use of these medications in 1,459 patients with bronchiolitis (median age 5.9 months) presenting at 30 emergency departments in 15 states.
Parents were asked about which over-the-counter drugs -- cough and cold medications, analgesics, rubs, vitamins, herbal medicines, etc. -- they had given to their children in the past week.
Nearly a third (30%, 95% CI 28% to 33%) had been given a cough and cold medication.
Children given the drugs were significantly older (7.6 versus 5.3 months, P<0.001) and more likely to be white (45% versus 38%, P=0.03) than those who did not receive them.
They were also more likely to attend daycare (31% versus 23%, P=0.001), to have been exposed to secondhand smoke (19% versus 14%, P=0.01), to have taken antibiotics (21% versus 14%, P=0.001), to have had symptoms for more than a week (24% versus 18%, P<0.001), and to present with wheezing (82% versus 75%, P=0.003).
Children given cough and cold medicine were also less likely to have a history of hospitalization (17% versus 23%, P=0.02).
In a multivariate analysis, use of the medications was predicted by an age of one year or older (OR 2.3, 95% CI 1.7 to 3.0, P<0.001) and by antibiotic use in the preceding week (OR 1.7, 95% 1.2 to 2.3, P=0.001).
Children younger than 12 months (OR 0.4, 95% CI 0.3 to 0.6, P<0.001) and those with a history of hospitalization (OR 0.6, 95% CI 0.4 to 0.8, P=0.001) were less likely to have been given cough and cold medications.
Dr. O'Donnell acknowledged that the study was limited by the use of self-reported data and by the fact that the results may not be generalizable to bronchiolitis patients who did not go to an emergency department.
Nonetheless, she said, "I think this is a good baseline rate of use and I think it's going to be important to look after the recall and see the impact that's had on use."
She noted, however, that surveys conducted shortly after the recall and FDA recommendation showed that many parents were still using cough and cold medications in children younger than two, which should "remind physicians to counsel patients about these medicines."
|The study was supported by the Thrasher Research Fund and by an unrestricted data analysis grant from Merck.
No financial conflicts were reported.
Zalman S. Agus, MD Emeritus Professor
University of Pennsylvania School of Medicine
Society for Academic Emergency Medicine meetingSource Reference: O'Donnell K, et al "Use of cough and cold medications in children age <two years presenting to the emergency department with bronchiolitis" SAEM Meeting 2008; Abstract 430.