Karnataka bars cough, cold syrups to children under two

BENGALURU: After reports of child deaths linked to the consumption of certain cough syrups in Madhya Pradesh and Rajasthan, the state government has advised both government and private healthcare institutions not to prescribe cough and cold syrups to children below the age of two years. In its advisory dated October 6, regarding the rational use of cough syrups in children, the Director of Department of Health and Family Welfare Services, said, For children between 2 to 5 years of age, such medications should generally be avoided, unless clearly indicated and prescribed after proper clinical evaluation. The circular recalled the Union Health Ministrys advisory dated October 3, which expressed concern over the irrational use of cough syrups in children. For older children, cough syrups, if required, must be used only after thorough clinical assessment, in the lowest effective dose and for the shortest duration, and fixed dose. Also, multi-drug combinations (irrational combinations, oral bronchodilators, cough suppressants) should be avoided, the director said, adding that all healthcare providers shall adhere to the Standard Treatment Protocols / Therapeutic Guidelines issued by the Ministry of Health and Family Welfare and the Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines for the clinical management of cough and respiratory symptoms in children. Further, the advisory directed that no cough suppressants should be used and Bronchodilators should be used only as inhalers and not in tablet or liquid form. He suggested that non-pharmacological measures such as adequate hydration, rest, supportive measures and a nutritious diet should be encouraged. Directing the healthcare facilities to ensure procurement of products only from Good Manufacturing Practice (GMP)-compliant licensed manufacturers, the district and taluk health authorities were asked to ensure wide dissemination of the advisory among paediatricians, general practitioners, pharmacists, and nursing staff and health institutions under their jurisdiction. The director asked officers to conduct random inspections to ensure compliance with the instructions and that the violations, irrational prescription, over-the-counter or use of unapproved fixed-dose combinations will attract action under the Karnataka Private Medical Establishments (KPME) Act, 2007, as well as under the Drugs and Cosmetics Act, 1940 and Rules, 1945. Any adverse events or suspected cases of cough syrup-related toxicity or death, as well as any unusual or unexplained increase in incidence of cough among children or the community, must be promptly investigated and reported in the IHIP (Integrated Health Information Platform) portal of the Integrated Disease Surveillance Programme (IDSP) Division, Directorate of Health & Family Welfare, the director said in the circular.