Doctors can recommend honey as an alternative to antibiotics for upper respiratory tract infections (URTI), say the authors of a systematic review published in BMJ Evidence Based Medicine.
A Cochrane review previously found that honey can improve cough in children, but honey has not been systematically reviewed in other patient groups or for other respiratory symptoms.
To address this knowledge gap, Hibatullah Abuelgasim and colleagues from the University of Oxford searched the literature for studies comparing honey and honey-containing preparations with usual care: mostly antihistamines, expectorants, cough suppressants, and analgesics.
They found 14 suitable clinical trials, involving 1761 participants of varying ages. Pooled data analysis of these studies showed that honey was more effective than usual care for improving symptoms, especially the frequency and severity of coughing.
Two of the studies showed that symptoms lasted 1-2 days fewer among those treated with honey.
The researchers note that honey is a complex substance and not a uniform product. They also acknowledge that only two of the studies involved a placebo control group, and more placebo-controlled studies need to be done before definitive conclusions can be reached.
But they point out: 'Upper respiratory tract infections are the most frequent reason for antibiotic prescription. Since the majority of URTIs are viral, antibiotic prescription is both ineffective and inappropriate'.
Honey might therefore provide an alternative when doctors want to prescribe something to safely treat upper respiratory tract symptoms, they suggest.
'Honey is a frequently used lay remedy that is well known to patients. It is also cheap, easy to access, and has limited harms,' they conclude. 'When clinicians wish to prescribe for URTI, we would recommend honey as an alternative to antibiotics. [It] is more effective and less harmful than usual care alternatives and avoids causing harm through antimicrobial resistance.'