What is the efficacy of honey versus expectorant (mucolytic) syrup in relieving cough?

From the Guidelines

Honey is generally recommended as a first-line treatment for cough, especially for children over 1 year of age, due to its natural antimicrobial properties and effectiveness in reducing cough symptoms. For mild to moderate coughs, try 2-5 ml of honey (about 1/2 to 1 teaspoon) as needed, particularly before bedtime. Honey works by coating the throat, reducing irritation, and has been shown in studies to be as effective as dextromethorphan (a common cough suppressant) for nighttime cough relief 1. Expectorant syrups containing guaifenesin (like Mucinex or Robitussin) work differently by thinning mucus to make coughs more productive, typically dosed at 200-400 mg every 4 hours for adults. While both are effective, honey is more natural with fewer side effects. However, never give honey to infants under 12 months due to botulism risk. For persistent coughs lasting more than 2 weeks, coughs with fever over 101°F, or difficulty breathing, consult a healthcare provider as these may indicate a more serious condition requiring different treatment.

Some key points to consider when choosing between honey and expectorant syrups include:

• Honey's natural antimicrobial properties and effectiveness in reducing cough symptoms
• Expectorant syrups' ability to thin mucus and make coughs more productive
• The importance of consulting a healthcare provider for persistent or severe coughs
• The potential risks of giving honey to infants under 12 months

It's also worth noting that other treatments, such as cough suppression exercises and pharmacological therapy, may be recommended for adult patients with lung cancer experiencing cough 1. However, for general cases of cough, honey is a recommended first-line treatment due to its natural properties and effectiveness.

From the Research

Comparison of Honey and Expectorant Syrup for Coughing

• Honey has been shown to be effective in relieving cough symptoms in upper respiratory tract infections, with studies indicating that it can improve combined symptom score, cough frequency, and cough severity compared to usual care 2.
• In comparison, expectorant syrups such as guaifenesin have limited evidence supporting their efficacy in relieving cough symptoms, with some studies suggesting that they may not provide greater relief than placebo in adults 3, 4.
• However, guaifenesin may be beneficial in relieving symptoms of rhinitis, such as thickening and drying of airway mucus, although the data is limited and equivocal 4, 5.
• A study comparing honey with dextromethorphan (an ingredient commonly found in expectorant syrups) found that honey may modestly decrease frequency and severity of cough compared to dextromethorphan or no treatment 3.
• Extended-release guaifenesin/pseudoephedrine hydrochloride has been shown to be safe and effective for adjunctive symptom relief of acute respiratory infections, although its efficacy in relieving cough symptoms specifically is not well established 6.

Key Findings

• Honey is a widely available and cheap alternative to antibiotics for relieving cough symptoms in upper respiratory tract infections 2.
• Expectorant syrups such as guaifenesin may have limited efficacy in relieving cough symptoms, although they may be beneficial in relieving symptoms of rhinitis 3, 4, 5.
• Further high-quality, placebo-controlled trials are needed to fully establish the efficacy of honey and expectorant syrups in relieving cough symptoms 2.