The Directorate General of Health Services (DGHS) has issued an advisory to all states and Union Territories on the rational use of cough syrups in children, following consumption-related deaths in Madhya Pradesh and Rajasthan.
In its communique, the DGHS advocates “judicious prescribing and dispensing of cough syrups for children,” arguing that most “acute cough illnesses in children are self-limiting and resolve without pharmacological intervention.” It further says that cough and cold medications should not be prescribed for children under two years. “These are generally not recommended for ages below five years and above that, any use should follow careful, clinical evaluation with close supervision and strict adherence to appropriate dosing, the shortest effective duration and avoiding multiple drug combinations,” the DGHS said. It highlighted the need for making everybody aware about adhering only to prescription by doctors.
As a first-line approach for children suffering from cough and cold, it has made a case for non-pharmacological measures, including “adequate hydration and rest.”
Since there have been reports that the deaths were caused by fake drugs, the DGHS has urged all healthcare facilities and clinical establishments to ensure “procurement and dispensing of products manufactured under good manufacturing practices and formulated with pharmaceutical-grade excipients.”
The advisory applies to health departments in all States/Union Territories, district health authorities, government dispensaries, primary healthcare centres (PHCs), community health centres (CHCs), district hospitals and medical institutions.
A multi-disciplinary team comprising experts from NCDC, NIV, ICMR, AIIMS Nagpur and state health authorities is investigating all possible causes behind the deaths. Although there have been reports of contamination and fake syrups, none of the samples tested so far contained diethylene glycol (DEG) or ethylene glycol (EG), contaminants that are known to cause serious kidney injury. The Madhya Pradesh State Food and Drug Administration (SFDA) also tested three samples and confirmed the absence of DEG/EG.
Further blood/CSF samples have been tested by NIV Pune for common pathogens. One case has been found positive for leptospirosis.
As regards the reports related to two deaths of children in Rajasthan because of contaminated cough syrup consumption, it has been clarified that the product in question did not contain propylene glycol, which can be a potential source of contaminants. Additionally, the product under reference is a dextromethorphan-based formulation, which is not recommended for paediatric use.(News Agency)
