From the Guidelines
For children with postnasal drip-induced cough, cetirizine (Zyrtec) is generally more effective and safer than diphenhydramine (Benadryl) for long-term management, as it provides 24-hour relief with minimal sedation and a better side effect profile 1.
Key Considerations
- The American Academy of Pediatrics and other guidelines recommend avoiding the use of diphenhydramine in children under 6 years of age due to the risk of toxicity and lack of efficacy 1.
- Cetirizine, a second-generation antihistamine, has been shown to be well-tolerated and effective in children, with a lower risk of sedation and other side effects compared to diphenhydramine 1.
- The typical dosage of cetirizine for children varies by age, with recommended doses of 2.5mg once daily for ages 2-5 years, 5-10mg once daily for ages 6-11, and 10mg once daily for children 12 and older.
Important Safety Information
- Diphenhydramine can cause significant sedation, disrupting sleep and daily activities, and has a higher risk of toxicity in young children 1.
- Cetirizine, while generally safer, should still be used with caution and under the guidance of a pediatrician, especially in children under 2 years of age.
Clinical Recommendations
- For children with postnasal drip-induced cough, cetirizine (Zyrtec) is the preferred treatment option due to its efficacy, safety, and minimal sedation 1.
- Benadryl (diphenhydramine) may be considered for severe nighttime symptoms, but its use should be limited and closely monitored due to its sedating properties and higher risk of toxicity 1.
- Always consult with a pediatrician before giving any antihistamine to children, especially those under 2 years of age, as they may need different treatment approaches for postnasal drip-induced cough.
From the Research
Comparison of Diphenhydramine and Cetirizine in Alleviating Postnasal Drip-Induced Cough
There are no direct studies comparing the effectiveness of diphenhydramine (Benadryl) and cetirizine (Zyrtec) in alleviating postnasal drip-induced cough in pediatric patients.
Available Evidence on Postnasal Drip-Induced Cough
- The concept of postnasal drip as a cause of cough in childhood is controversial, and a definitive diagnosis of cough induced by postnasal drip cannot be made from history and physical examination alone 2.
- A study on salso-bromo-iodine thermal water as a treatment for postnasal drip-related cough in children with upper respiratory tract infections showed promising results, with improved symptoms and quality of life compared to a normal saline solution 3.
- Guidelines for the treatment of cough in children recommend an etiology-based approach, with no scientific evidence to justify the use of over-the-counter cough remedies, including antihistamines like diphenhydramine and cetirizine 4, 5.
- A study on the treatment of cough attributable to "postnasal drip syndrome" with sinupret showed effectiveness in managing coughing dynamics, but did not compare antihistamines like diphenhydramine and cetirizine 6.
Limitations of Current Evidence
- The available studies do not provide a direct comparison of diphenhydramine and cetirizine in alleviating postnasal drip-induced cough in pediatric patients.
- The effectiveness of antihistamines in treating postnasal drip-induced cough in children is not well-established, and more research is needed to determine their efficacy and safety in this population.