The Directorate General of Health Services on Friday issued an advisory to all states and Union Territories, reiterating the “judicious prescribing and dispensing” of cough syrups for children, ANI reported.

This came after deaths allegedly linked to the consumption of cough syrups in Madhya Pradesh and Rajasthan.

The department, which reports to the Union health ministry, said that most “acute cough illnesses in children are self-limiting and resolve without pharmacological intervention”, adding that cough and cold medications should not be prescribed for children under two years.

“These are generally not recommended for ages below five years and above that, any use should follow careful, clinical evaluation with close supervision and strict adherence to appropriate dosing, the shortest effective duration and avoiding multiple drug combinations,” the health authority said.

The public should be sensitised about adhering only to prescription by doctors, the advisory said.

It added that non-pharmacological measures, including “adequate hydration and rest”, should be the first-line approach for children suffering from cough and cold.

Health facilities and clinics must ensure the procurement and dispensing of products manufactured under the Good Manufacturing Practices and formulated pharmaceutical-grade excipients, it added.

Eight children, aged between one and seven, died in the past month in Madhya Pradesh and Rajasthan. The authorities have suspected cough syrup poisoning as the common cause.

In both states, health authorities had issued restrictions and advisories, and investigations were underway.

The Times of India quoted the Union health ministry as having said on Friday that the tests on the cough syrup samples taken from Madhya Pradesh revealed that it did not contain “Diethylene Glycol (DEG) or Ethylene Glycol (EG), contaminants that are known to cause serious kidney injury”.

The samples collected from Rajasthan did not have “Propylene Glycol, which can be potential source of contaminants, DEG/EG”.

However, the ministry was quoted as saying that the product “is a dextromethorphan-based formulation, which is not recommended for paediatric use”.

Deaths due to toxic cough syrups manufactured in India first made headlines in October 2022, when the World Health Organization issued a global alert for four such medicines manufactured by a Haryana-based pharmaceutical firm.

This was after the authorities in The Gambia linked 66 deaths, most of them due to acute kidney failure, to the four medicines.

The usual cause of toxicity in cough syrups has been the use of industrial-grade glycerine or propylene glycol instead of pharmaceutical-grade versions. Industrial-grade variants are cheaper but can be contaminated with diethylene glycol or ethylene glycol which can cause diarrhoea, altered mental status, acute kidney injury, and lead to death, especially in children.

In July 2024, cough syrup samples taken from over 100 pharmaceutical units across India failed tests for quality control.

Also read: India’s cough syrup testing regime has a deadly blind spot

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