What is the best over-the-counter (OTC) medication for a cough caused by a viral infection in a 13-year-old?

Best OTC Medication for Viral Cough in a 13-Year-Old

Honey is the best over-the-counter treatment for cough caused by viral infection in a 13-year-old, as it offers more relief than no treatment, diphenhydramine, or placebo, with fewer side effects than pharmacological options. 1

First-Line Approach: Non-Pharmacological Options

• Viral cough is almost invariably benign and often does not require medication 1
• Honey is recommended as the simplest, cheapest, and often effective first-line treatment for viral cough in children 1, 2
• Simple voluntary suppression of cough may be sufficient to reduce cough frequency through central modulation of the cough reflex 1

OTC Medication Considerations for Children

• Most OTC cough medications have little to no benefit in the symptomatic control of cough in children 1
• The FDA has issued warnings against using OTC cough medications in young children due to potential serious side effects 1
• OTC preparations containing antihistamines and dextromethorphan have been associated with adverse events in children, including reported deaths from toxicity 1

Pharmacological Options (If Needed)

Dextromethorphan

• Dextromethorphan is a non-sedating opiate that suppresses the cough reflex 1, 3
• While it has shown efficacy in adults, evidence for effectiveness in children is limited 4, 5
• If used, dosing should be carefully considered as there may be a dose-response relationship in children 6
• The American Academy of Pediatrics has raised concerns about the use of dextromethorphan-containing cough remedies in children 7

Menthol

• Menthol by inhalation can provide acute but short-lived cough suppression 1
• Can be used as menthol crystals or proprietary capsules 1

First-Generation Antihistamines

• First-generation antihistamines with sedative properties can suppress cough 1
• May be useful for nocturnal cough due to sedative effects 1
• However, efficacy in children is minimal if at all 1

Medications to Avoid

• Codeine and pholcodine have no greater efficacy than dextromethorphan but have much greater adverse side effect profiles 1
• The FDA has altered labeling for prescription opioid cough medicines to limit their use to adults ≥18 years 1
• Codeine-containing medications should be avoided due to potential for serious side effects including respiratory distress 1

Monitoring and Follow-Up

• If any medication is used, the child should be reevaluated in 2-4 weeks 1
• If cough does not resolve during the medication trial within the expected response time, the medication should be withdrawn and other diagnoses considered 1
• Environmental factors such as exposure to tobacco smoke should be addressed 1

Special Considerations

• Cough with increasing breathlessness should be assessed for asthma or anaphylaxis 1
• Cough with fever, malaise, purulent sputum may indicate serious lung infection 1
• Significant hemoptysis or possible foreign body inhalation requires specialist referral 1