Over-the-counter Cough & Cold Medications

Several Factors Contribute to Child Deaths Due to Nonprescription Cough, Cold Meds

From Reuters Health Information

Health) Apr 29 - Pediatric fatalities associated with over-the-counter cough and cold medications are uncommon, generally involve overdose with or without therapeutic intent, and mainly affect children younger than 2 years, according to findings reported in the April issue of the Annals of Emergency Medicine.

"Cough and cold products have been sporadically associated with severe toxicity and death in children," Dr. Richard C. Dart, of the University of Colorado School of Medicine, Aurora, and colleagues write. In 2005 in the US, 28 of 64,658 cases of poisonings in children due to these products resulted a major adverse effect or death

An expert panel was convened to examine factors contributing to fatalities involving child younger than 12 years related to a cough or cold remedies.

A total of 189 cases were identified. Eleven of these were excluded, leaving 178 cases. Of these, the panel concluded that a relationship between the cough and cold ingredient and the fatality was at least possible in 118 cases. Overall, 82 cases involved a nonprescription medication alone, 21 cases involved exposure to both a nonprescription and prescription medication, and 15 cases involved only a prescription medication.

The team reports that in the 103 cases that involved nonprescription medications, ingredients most often mentioned were pseudoephedrine (n = 45), diphenhydramine (n = 38), and dextromethorphan (n = 36).

Of these cases, 88 were judged to have involved an overdose. Insufficient information was available for the remaining 15 cases to estimate the dose.

"The intent of caregivers appears to be therapeutic to relieve symptoms in some cases and nontherapeutic to induce sedation or to facilitate child maltreatment in other cases," the investigators report.

A number of contributing factors were identified, including age younger than 2 years, use of the medication for sedation, use in a daycare setting or babysitter home, use of two medicines with the same ingredient, failure to use a measuring device, product misidentification, and use of a product intended for adults.

"Many of the factors related to inadvertent overdose identified by the expert panel are preventable and interventions could potentially reduce the deaths associated with cough and cold products substantially," Dr. Dart's team explains. "A successful public health intervention requires clear identification of contributing factors, implementation of effective tools to address each factor, and ongoing active surveillance to document the effect of interventions and to detect new developments."

Ann Emerg Med 2009;53:411-417.
http://www.medscape.com/viewarticle/702083?sssdmh=dm1.465854&src=nldne