Honey superior to usual care for upper respiratory tract infections, review finds

A meta-analysis and review found that honey relieved symptoms such as cough better than usual care, but it had not been proven superior to placebo in a randomized, controlled trial.

Honey appears more effective than usual care for improving upper respiratory tract infections (URTI) symptoms, particularly cough frequency and cough severity, a review found.

To evaluate the effectiveness of honey for symptomatic relief in URTIs, researchers conducted a systematic review and meta-analysis of 14 studies, nine of them exclusively pediatric, with overall moderate risk of bias. Results appeared in BMJ Evidence-Based Medicine.

Compared with usual care, honey improved combined symptom score (three studies; mean difference, −3.96; 95% CI −5.42 to −2.51), cough frequency (eight studies; standardized mean difference [SMD], −0.36; 95% CI −0.50 to −0.21) and cough severity (five studies; SMD, −0.44; 95% CI −0.64 to −0.25). Researchers combined two studies comparing honey with placebo for relieving combined symptoms (one finding honey was superior, one finding it was not) with the overall result that honey was not superior to placebo. The researchers also combined studies to compare honey to dextromethorphan (two studies) and diphenhydramine (four studies). They found it improved outcomes significantly more than the latter, but not the former.

A limitation was the risk of bias in the included studies, and there was limited information on how patients in the placebo arms were asked not to take honey and on how their adherence was measured. Also, some studies included in the honey group included treatments with syrups, milk, or coffee, making it difficult to know how much of any effect was due to honey alone. “If the effect of honey is mediated through forming a soothing mechanical barrier, then these comparators could have a similar effect to honey, biasing the results towards the null,” the authors said.

Comparisons with placebo were more limited, and more high-quality, placebo-controlled trials are needed, the authors said. There are currently very few effective options that clinicians can prescribe for URTIs, and honey can be used as an alternative to antibiotics by clinicians who wish to offer treatment and combat antimicrobial resistance, they wrote.

“Honey is a frequently used lay remedy that is well known to patients,” the authors wrote. “It is also cheap, easy to access and has limited harms. When clinicians wish to prescribe for URTI, we would recommend honey as an alternative to antibiotics.”