Use of Codeine-and Dextromethorphan-Containing Cough Syrups in Pediatrics

In making decisions regarding the use of centrally acting antitussives, the practitioner must first consider the indications for the use of any antitussive agent; then, the efficacy and safety of the available agents as compared to those of a nondrug, alternative course of therapy must be considered. As stated in an editorial in the British Medical Journal,1 "the fact that a patient has a cough does not indicate that he needs treatment for it." Nevertheless, we acknowledge the traditional, frequent prescribing and self-administration of antitussive products and the almost placebo nature of many of them. Indications and Contraindications Coughs may be considered reflex responses to mechanical or chemical irritation of the tracheobronchial tree that are mediated by a brainstem "cough center." Thus, coughing serves the beneficial functions of clearing airways of obstructing or irritating material and warning against noxious substances in inspired air.2 In pathologic states (e.g., asthma, chronic obstructive pulmonary disease, chronic bronchitis, and cystic fibrosis), the cough reflex serves to maintain airway patency by clearing excessive secretions. Cough suppression in patients with these conditions may be not only counterproductive but also directly harmful. Clearing of secretions filling the tracheobronchial tree of these patients is essential to management. In other diseases (e.g., influenza), coughing simply may be a response to inflammation of the respiratory epithelium; however, a truly "nonproductive" cough is unusual in infants and young children. Rarely, nonproductive coughing may be severe enough to cause emesis, exhaustion, and loss of sleep. A cough is usually a mild symptom of the common cold, but even in this instance clearing of secretions is probably beneficial.