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5MinuteConsult Journal Club

Honey Is As, If Not MORE Effective for URIs Than Commonly Used Treatments 


Reference 

Abuelgasim H, Albury C, Lee J. Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis [published online ahead of print, 2020 Aug 18]. BMJ Evid Based Med. 2020;bmjebm-2020-111336. doi:10.1136/bmjebm-2020-111336. PMID: 32817011 

Study Summary 

This is a systematic review and meta-analysis, an I2 less than 50 implies the risk due to the heterogeneity is LOW and the conclusion is likely significant.

Honey improved a combined symptom score (3 studies, mean difference −3.96, 95% CI −5.42 to −2.51, I2=0%), cough frequency (8 studies, standardized mean difference (SMD) −0.36, 95% CI −0.50 to −0.21, I2=0%) and cough severity (5 studies, SMD −0.44, 95% CI −0.64 to −0.25, I2=20 when compared to “usual care.” 

In 2 studies, honey was as effective as dextromethorphan at controlling cough severity and frequency and in 4 studies, honey was found to be superior to diphenhydramine in combined outcomes, and for cough severity and cough frequency. 

Conclusion 

Honey is safe and at least as effective as any other treatments for upper respiratory tract infections and has the potential to decrease the risks associated with inappropriate antibiotic use, including drug-related diarrhea. 

Discussion 

Really, this could not be easier. Tell patients that you have the BEST treatment for their colds: honey. Let’s face it, when you do not feel well, a tablespoon of honey, every 2 hours, is great—alone, or in a cup of tea with a squeeze of lemon. The only contraindication is age under 1 year on the unlikely chance of botulism. 

Stats Refresher 

This study found honey was effective for “cough severity (5 studies, SMD −0.44, 95% CI −0.64 to −0.25, I2=20 when compared to “usual care.” What does “I2=20” mean? I2 is a measure of how heterogeneous the included studies were—that means how different they were from each other regarding research methods, clinical aspects (patients, etc.), and statistical methods. The lower the I2, the less “different” the studies. 

In a meta-analysis, an I2 less than 50 implies the risk is LOW and the conclusion is less significant due to the heterogeneity. If the I2 is over 50, then the heterogeneity of the studies is significant and the meta-analysis’s conclusions may be inaccurate. 

More from 5MinuteConsult 

Upper Respiratory Infection (URI) 

Contributed by Frank J. Domino, MD, March 17, 2021

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