Honey is better than usual care for easing upper respiratory tract symptoms, especially cough, finds a synthesis of available evidence, published in BMJ Evidence Based Medicine.
Honey is cheap, readily available and has virtually no side effects, and doctors can recommend it as a suitable alternative to antibiotics, say the researchers.
Honey has long been used as a home remedy to treat coughs and colds. There is evidence for its use in children, but the evidence for its effectiveness for upper respiratory tract symptoms in adults has not been systematically reviewed.
In this study, researchers from the University of Oxford carried out a systematic review and meta-analysis of relevant studies published on Pubmed, Embase, Web of Science, Allied and Complementary Medicine Database (AMED), Cab abstracts, Cochrane Library, Literatura Latino Americana em Ciências da Saúde (LILACS) and Cumulative Index of Nursing and Allied Health Literature (CINAHL).
A total of 1345 unique records and 14 studies involving 1761 participants of varying ages were identified. There was considerable diversity of 'usual care' interventions, which included diphenhydramine, carbocysteine syrup, dextromethorphan, levodropropizine, paracetamol, naproxen and chlorpheniramine.
Nine studies used pure honey, two used Grintuss syrup (a cough suppressant syrup containing honey and plant complexes) and one used Honitus syrup (an ayuverdic honey syrup containing herb extracts). Two combined honey with coffee and one with milk.
Compared with usual care, honey improved combined symptom score (three studies; mean difference, −3.96; 95% CI, −5.42 to −2.51; I2=0%), cough frequency (eight studies; standardised mean difference (SMD), −0.36; 95% CI, −0.50 to −0.21; I2=0%) and cough severity (five studies; SMD, −0.44; 95% CI, −0.64 to −0.25; I2=20%).
Two studies compared honey with placebo for relieving combined symptoms (SMD, −0.63; 95% CI, −1.44 to 0.18; I2=91%).
Overall risk of bias was moderate.
The authors say honey could be an alternative to antibiotics in patients with upper respiratory symptoms, helping to slow the spread of antimicrobial resistance. However, they say, further high-quality, placebo-controlled trials are needed.