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 the deaths of several children in Madhya Pradesh and Rajasthan allegedly linked to their consumption.
In its communication, the DGHS urged doctors and pharmacists to be ‘judicious’ in prescribing and dispensing cough syrups for children. It said most acute cough illnesses in children are self-limiting and get better on their own without medication. The advisory aims to prevent unnecessary and unsafe use of cough syrups in paediatric cases.
Cough syrups not recommended for children under five
The DGHS advisory clearly states that cough and cold syrups should not be prescribed for children below two years of age, and are generally not recommended for those below five. For kids above five, cough syrups should be given only after a doctor’s check-up and approval. Parents should stick to the exact dose prescribed by the doctor and must not use it for long.
The DGHS also warned against mixing different medicines, as that can increase the chances of side effects. Instead, the advisory suggested that parents must follow simple home remedies like keeping the child hydrated, and must rest well.
Most coughs and colds get better on their own, so parents should avoid self-medicating and give medicines only if prescribed by a doctor.
DGHS flags concern over fake or contaminated syrups
The advisory comes after reports suggested that fake or substandard cough syrups could have played a role in the child deaths. The DGHS directed healthcare facilities to procure and dispense only products manufactured under good manufacturing practices (GMP) and using pharmaceutical-grade ingredients.
A multi-disciplinary team comprising experts from the NCDC, NIV, ICMR, AIIMS Nagpur, and state health authorities is investigating the deaths. So far, no samples have shown the presence of diethylene glycol (DEG) or ethylene glycol (EG), the toxic substances previously linked to mass poisoning incidents globally. The Madhya Pradesh State Food and Drug Administration also confirmed that the three tested samples were free from these contaminants.
Early investigation findings
According to the National Institute of Virology (NIV), Pune, blood and cerebrospinal fluid samples revealed one case positive for leptospirosis, a bacterial infection that can affect the kidneys and liver.
In Rajasthan, two child deaths were initially linked to a contaminated syrup. However, the DGHS clarified that the product did not contain propylene glycol, another possible contaminant. The syrup was a dextromethorphan-based formulation, which is not recommended for paediatric use.
Parents advised against self-medication
The DGHS has urged parents to avoid self-medicating children and to doctor’s advice before giving any cough or cold syrup. The advisory also states that most childhood coughs recover naturally, and using unnecessary medication can sometimes do more harm than good.