Bromfed DM Should NOT Be Used in Children Aged 7-9 Years with Cough
Do not prescribe Bromfed DM or any over-the-counter cough and cold medications to children aged 7-9 years with cough, as major clinical guidelines explicitly recommend against their use due to lack of efficacy and potential for significant morbidity and mortality. 1
Why This Medication Should Be Avoided
Guideline Recommendations Are Clear
The American College of Chest Physicians (ACCP) evidence-based guidelines state that cough suppressants and other over-the-counter cough medicines should not be used in children, as patients, especially young children, may experience significant morbidity and mortality (Grade D recommendation with good level of evidence). 1
The American Academy of Pediatrics specifically advises against using dextromethorphan (one of the three active ingredients in Bromfed DM) for any type of cough in children, as systematic reviews demonstrate little to no benefit in symptomatic control of acute cough. 2, 3
Documented Safety Concerns
Between 1969 and 2006, there were 54 deaths associated with decongestants (like pseudoephedrine in Bromfed DM) and 69 deaths associated with antihistamines (like brompheniramine in Bromfed DM) in children under 6 years. 2
The FDA drug label for Bromfed DM explicitly states that safety and effectiveness in pediatric patients below the age of 6 months have not been established, and provides no clear safety data for the 7-9 year age group. 4
Antihistamine-decongestant combination products (exactly what Bromfed DM is) have been proven ineffective for upper respiratory tract infection symptoms in young children in controlled trials. 2
What You Should Do Instead
First-Line Treatment: Honey
For children over 1 year old, honey is the recommended first-line treatment for acute cough, as it provides more relief than no treatment, diphenhydramine, or placebo. 5, 3
Typical dosing: 2.5-5 mL of honey as needed, particularly before bedtime. 3
Address Underlying Causes
For wet/productive cough lasting >4 weeks: Consider protracted bacterial bronchitis and treat with a 2-week course of antibiotics targeting common respiratory bacteria. 5
For dry cough with asthma features (wheeze, exercise intolerance, nocturnal symptoms): Consider a 2-4 week trial of inhaled corticosteroids (beclomethasone 400 μg/d or equivalent budesonide). 1, 5
Evaluate and eliminate environmental triggers: Specifically assess for tobacco smoke exposure and other environmental pollutants. 1, 5
When to Reassess
If cough persists beyond 2-4 weeks, reevaluate for emergence of specific etiologic pointers rather than continuing symptomatic treatment. 1, 3
Consider chest radiograph and spirometry as first-line investigations if chronic cough develops. 5
Critical Pitfalls to Avoid
Do not prescribe combination cough/cold products due to parental pressure, despite their common use in some clinics—the evidence clearly shows no benefit and potential harm. 1, 3
Avoid the misconception that "prescription strength" means more effective or safer—Bromfed DM contains the same problematic ingredients as OTC products, just in a prescription formulation. 2
Do not assume all coughs require medication—most acute coughs from viral upper respiratory infections are self-limiting and require only supportive care. 3
Never use multiple cough/cold products simultaneously, as this is a common cause of adverse events from inadvertent overdose of the same ingredients. 4, 6