蜂蜜は咳に有効

University of Calabar Teaching HospitalのOlabisi Oduwole氏らは、小児の急性咳嗽に対する蜂蜜の有効性を評価するためにシステマティックレビューを実施し、2018年4月10日、Cochrane Database of Systematic Reviewsに公開した。本レビューは、2010、2012、2014年に続く更新。本レビューの結果、蜂蜜は、無治療、ジフェンヒドラミン、プラセボと比較して、咳症状を多くの面で軽減するが、デキストロメトルファンとはほとんど差がない可能性が示唆された。また、咳の持続時間についてはサルブタモール、プラセボより短縮する可能性はあるが、蜂蜜使用の優劣を証明する強固なエビデンスは認められなかったと結論している。

　著者らは、MEDLINE、Embase、CENTRAL（Cochrane Acute Respiratory Infections Group's Specialised Registerを含む）などをソースとして、2014～18年2月のデータを検索した。また、2018年2月にはClinicalTrials.govとWHOのInternational Clinical Trial Registry Platformも同様に検索した。対象とした試験は、急性の咳症状で外来受診した12ヵ月～18歳の小児に対する治療（蜂蜜単独、蜂蜜と抗菌薬の併用、無治療、プラセボ、蜂蜜ベースの咳止めシロップ、その他の咳止め薬）における無作為化比較試験で、899例の小児を含む6試験。今回の更新で、3試験331例の小児が追加された。これらの試験では、蜂蜜をデキストロメトルファン、ジフェンヒドラミン、サルブタモール、ブロメライン（パイナップル科の酵素）、無治療、プラセボと比較していた。

＜結果＞

★蜂蜜は、無治療、プラセボより咳の頻度を減らす可能性がある。無治療との平均差（MD）は－1.05（95％CI：－1.48～－0.62、I2＝0％、2試験・154例、エビデンスの確実性は中）、プラセボとのMDはｰ1.62（95％CI：ｰ3.02～ｰ0.22、I2＝0％、2試験・402例、エビデンスの確実性は中）であった。

★蜂蜜は、デキストロメトルファンと同程度、咳の頻度を減らす可能性がある（MD：ｰ0.07、95％CI：ｰ1.07～0.94、I2＝87％、2試験・149例、エビデンスの確実性は低）。

★蜂蜜は、ジフェンヒドラミンより咳の頻度を減らす可能性がある（MD：ｰ0.57、95％CI：ｰ0.90～ｰ0.24、1試験・80例、エビデンスの確実性は低）。

★咳症状の緩和を目的とした蜂蜜の投与は、3日以内は効果的である可能性があるが、3日を超える投与は、咳の重症度、わずらわしい咳、親子の睡眠への咳の影響を減少させることにおいて、プラセボやサルブタモールを上回る優位性がない（エビデンスの確実性は中）。

★咳尺度を用いた5試験では、蜂蜜と、蜂蜜を混ぜたブロメラインを比較して、咳の頻度と重症度を下げる効果にほとんど差がなかった。

★有害事象については、蜂蜜群と対照群に差はなかった。

Honey for acute cough in children.

Olabisi Oduwole, Ekong E Udoh, Angela Oyo-Ita, Martin M Meremikwu

The Cochrane database of systematic reviews. 2018 Apr 10;4;CD007094. doi: 10.1002/14651858.CD007094.pub5.

Abstract

BACKGROUND :

Cough causes concern for parents and is a major cause of outpatient visits. Cough can impact quality of life, cause anxiety, and affect sleep in children and their parents. Honey has been used to alleviate cough symptoms. This is an update of reviews previously published in 2014, 2012, and 2010.

OBJECTIVES :

To evaluate the effectiveness of honey for acute cough in children in ambulatory settings.

SEARCH METHODS :

We searched CENTRAL (2018, Issue 2), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (2014 to 8 February 2018), Embase (2014 to 8 February 2018), CINAHL (2014 to 8 February 2018), EBSCO (2014 to 8 February 2018), Web of Science (2014 to 8 February 2018), and LILACS (2014 to 8 February 2018). We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trial Registry Platform (WHO ICTRP) on 12 February 2018. The 2014 review included searches of AMED and CAB Abstracts, but these were not searched for this update due to lack of institutional access.

SELECTION CRITERIA :

Randomised controlled trials comparing honey alone, or in combination with antibiotics, versus no treatment, placebo, honey-based cough syrup, or other over-the-counter cough medications for children aged 12 months to 18 years for acute cough in ambulatory settings.

DATA COLLECTION AND ANALYSIS :

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS :

We included six randomised controlled trials involving 899 children; we added three studies (331 children) in this update.We assessed two studies as at high risk of performance and detection bias; three studies as at unclear risk of attrition bias; and three studies as at unclear risk of other bias.Studies compared honey with dextromethorphan, diphenhydramine, salbutamol, bromelin (an enzyme from the Bromeliaceae (pineapple) family), no treatment, and placebo. Five studies used 7-point Likert scales to measure symptomatic relief of cough; one used an unclear 5-point scale. In all studies, low score indicated better cough symptom relief.Using a 7-point Likert scale, honey probably reduces cough frequency better than no treatment or placebo (no treatment: mean difference (MD) -1.05, 95% confidence interval (CI) -1.48 to -0.62; I² = 0%; 2 studies; 154 children; moderate-certainty evidence; placebo: MD -1.62, 95% CI -3.02 to -0.22; I² = 0%; 2 studies; 402 children; moderate-certainty evidence). Honey may have a similar effect as dextromethorphan in reducing cough frequency (MD -0.07, 95% CI -1.07 to 0.94; I² = 87%; 2 studies; 149 children; low-certainty evidence). Honey may be better than diphenhydramine in reducing cough frequency (MD -0.57, 95% CI -0.90 to -0.24; 1 study; 80 children; low-certainty evidence).Giving honey for up to three days is probably more effective in relieving cough symptoms compared with placebo or salbutamol. Beyond three days honey probably had no advantage over salbutamol or placebo in reducing cough severity, bothersome cough, and impact of cough on sleep for parents and children (moderate-certainty evidence). With a 5-point cough scale, there was probably little or no difference between the effects of honey and bromelin mixed with honey in reducing cough frequency and severity.Adverse events included nervousness, insomnia, and hyperactivity, experienced by seven children (9.3%) treated with honey and two children (2.7%) treated with dextromethorphan (risk ratio (RR) 2.94, 95% Cl 0.74 to 11.71; I² = 0%; 2 studies; 149 children; low-certainty evidence). Three children (7.5%) in the diphenhydramine group experienced somnolence (RR 0.14, 95% Cl 0.01 to 2.68; 1 study; 80 children; low-certainty evidence). When honey was compared with placebo, 34 children (12%) in the honey group and 13 (11%) in the placebo group complained of gastrointestinal symptoms (RR 1.91, 95% CI 1.12 to 3.24; I² = 0%; 2 studies; 402 children; moderate-certainty evidence). Four children who received salbutamol had rashes compared to one child in the honey group (RR 0.19, 95% CI 0.02 to 1.63; 1 study; 100 children; moderate-certainty evidence). No adverse events were reported in the no-treatment group.

AUTHORS' CONCLUSIONS :

Honey probably relieves cough symptoms to a greater extent than no treatment, diphenhydramine, and placebo, but may make little or no difference compared to dextromethorphan. Honey probably reduces cough duration better than placebo and salbutamol. There was no strong evidence for or against using honey. Most of the children received treatment for one night, which is a limitation to the results of this review. There was no difference in occurrence of adverse events between the honey and control arms.

よくハチミツは咽頭痛を改善させると信じられていますが、実際デビデンスがあるのは咳に対してです。

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＜方法＞

Pubmed、Embase、Web of Science、AMED、Cab abstracts、Cochrane Library、LILACS、およびCINAHLを、キーワードとMeSH用語の組み合わせで検索し、方法系統的レビューとメタ解析を行った。

＜結果＞

1345の固有のレコードを特定し、14の研究が含まれました。バイアスの全体的なリスクは中程度でした。

通常のケアと比較して、蜂蜜は複合症状スコアを改善しました。（3つの研究、平均差-3.96、[95％CI: -5.42 to -2.51]、I2 = 0％）、

咳の頻度（8件の研究、標準化された平均差（SMD）-0.36、[95％CI: -0.50 to -0.21]、I2 = 0％）、

および咳の重症度（5つの研究、SMD -0.44、[95％CI: -0.64 to -0.25]、I2 = 20％）はいずれも改善されました。

複合症状を緩和するために、蜂蜜とプラセボを比較した2つの研究を組み合わせ、以下のように改善しました。

（SMD -0.63、[95％CI: -1.44 to 0.18]、I2 = 91％）

＜結論＞

蜂蜜は、上気道感染症の症状の改善に関して通常のケアよりも優れていました。それは抗菌薬の広く利用可能で安価な代替品を提供します。蜂蜜は抗菌薬耐性の広がりを遅らせる努力を助けますが、さらに高品質のプラセボ対照試験が必要です。

Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis

Hibatullah Abuelgasim, Charlotte Albury, Joseph Lee

https://ebm.bmj.com/content/26/2/57

Abstract

Background Antibiotic over prescription for upper respiratory tract infections (URTIs) in primary care exacerbates antimicrobial resistance. There is a need for effective alternatives to antibiotic prescribing. Honey is a lay remedy for URTIs, and has an emerging evidence base for its use. Honey has antimicrobial properties, and guidelines recommended honey for acute cough in children.

Objectives To evaluate the effectiveness of honey for symptomatic relief in URTIs.

Methods A systematic review and meta-analysis. We searched Pubmed, Embase, Web of Science, AMED, Cab abstracts, Cochrane Library, LILACS, and CINAHL with a combination of keywords and MeSH terms.

Results We identified 1345 unique records, and 14 studies were included. Overall risk of bias was moderate. 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%). We combined two studies comparing honey with placebo for relieving combined symptoms (SMD −0.63, 95% CI −1.44 to 0.18, I²=91%).

Conclusions Honey was superior to usual care for the improvement of symptoms of upper respiratory tract infections. It provides a widely available and cheap alternative to antibiotics. Honey could help efforts to slow the spread of antimicrobial resistance, but further high quality, placebo controlled trials are needed.

Eccles R, et al. Respir Physiol Neurobiol. 2006 Jul 28;152(3):340-8.

Raeessi MA, et al. Prim Care Respir J. 2013;22:325-330.

Paul IM, et al. Arch Pediatr Adolesc Med. 2007 Dec;161(12):1140-6.

Cohen HA, et al. Pediatrics. 2012 Sep;130(3):465-71.

Oduwole O, et al. Cochrane Database Syst Rev. 2018 Apr 10;4(4):CD007094.

Abuelgasim H, et al. BMJ Evid Based Med . 2021 Apr;26(2):57-64.