Inside India’s Cough Syrup Obsession

It’s happening again.

In early September, unexplained child deaths in a small town in Madhya Pradesh had local health workers scrambling.

At least 19 victims (ages 1 to 6) died within a few weeks of taking common cough syrup. Officials tested everything from drinking water to mosquitoes before the truth emerged. My kidneys have failed.

A few weeks later, a state laboratory south of Chennai confirmed the worst. The syrup in question contains 48.6% diethylene glycol, a toxic industrial solvent that should never be found in medicine. Kidney failure is common after consuming this toxic alcohol.

The horror was not limited to Madhya Pradesh. In the neighboring state of Rajasthan, the deaths of two young children were suspected to have occurred after consuming locally manufactured dextromethorphan syrup, which gave the very young children cough suppressant anxiety.

For India, this has led to a cruel sense of déjà vu.

Over the years, diethylene glycol in Indian-made cough syrup has claimed dozens of young people. In 2023, Indian syrup contaminated with diethylene glycol was linked to the deaths of 70 children in Gambia and 18 in Uzbekistan.

Between December 2019 and January 2020, fewer than five children died in Jammu, Kashmir, from Indian administered cough syrup, and activists have suggested the casualty toll could be higher. It was like that in the past Cough syrup abuse containing codeineMild opioids, which produce euphoria in high doses and can cause dependence, are not recommended for young children.

Every time regulators promise reform, tainted syrup reappears. It reflects a fragmented drug market and a weak regulatory system that critics say struggles to oversee the hundreds of low-cost, unapproved syrups produced by small manufacturers and sold over the counter.

Days after recent child deaths, India’s health ministry “reasonable” The use of these medicines – effectively warning doctors to exercise greater caution when prescribing them to children – led to samples of the syrup being confiscated, sales halted, banned and an investigation ordered.

But critics say the problem goes deeper than excessive radiation. Each new tragedy exposes corruption in India’s drug oversight system – a maze of weak enforcement and regulation. India Cough Syrup Market to Soar from USD 262.5 Million in 2024 to USD 74.3 Million by 2035 Compound Annual 9.9%According to market research Future.

But none of this would happen if India and Indians could escape their obsession with cough syrup. For decades, doctors have been prescribing them, and patients have been taking them, even though most do little good and can potentially cause serious harm.

Marketed as quick relief for the sore throat and stubborn cough, this sweet syrup combines sugar, color and flavoring with a cocktail of antihistamines, decongestants, and laxatives.

In theory, each ingredient plays a role. One has dry secretions, another loosens phlegm, and the third dulls the cough reflex. In reality, the evidence that it does much good is small. Most coughs get better on their own within a few days.

Coughing can be caused by an infection or allergic reaction. Cough syrups fall broadly into two types: sedatives, which help the child relax, and bronchodilators, which ease breathing.

According to Dr Rajaram D Khare, a Mumbai-based pediatrician, most persistent coughs in children in India’s increasingly polluted cities are caused not by infections but by allergies and irritation of the lower respiratory tract. Allergies occur when the immune system overreacts to triggers such as dust and pollution.

These children often have cold or runny noses and coughs that get worse at night or early in the morning and return every few weeks. He said that in large cities such a recurrent wet cough is usually triggered by dust and smog and is sometimes accompanied by mild bronchospasm.

Dr. Khare said these coughs respond best to bronchodilators, which are medicines that open the vessels.

Most childhood coughs are viral, self-limiting, and resolve on their own within a week. Doctors say that syrup does not shorten its course. At best, they provide cozy comfort. In the worst case, there is a risk of poisoning, toxicity and overdose.

“I usually don’t prescribe cough syrups for run-of-the-mill coughs and colds, except for the occasional cough for comfort. If a child is coughing badly and can’t sleep, you may give them a mild syrup to ease the discomfort. The main goal is treatment, especially when the cough is dry and part of a viral infection,” says Dr. Khare.

So why is cough syrup widely prescribed in India?

One reason is the weakness of India’s primary health care system, especially in small cities and rural areas. Air pollution fuels incessant coughing and is increasingly misused for routine respiratory infections.

The problem runs deeper in the countryside. In rural India, the largest 75% of primary care visits are handled by informal providers. – Autonomous “RMPs” or rural health workers, often without formal medical training.

In places where local public health clinics are remote, remote or closed, you are your de facto doctor and Syrup is your most reliable tool. “Even people without degrees remember syrup being handed out everywhere,” says pediatrician Dr. Kafeel Khan, posted in Gorakhapur, a city in Uttar Pradesh.

In many of these cities, patients rely on medically knowledgeable people, from informal practitioners to shopkeepers, to manage their everyday cough.

“Many poor patients are seeking advice from their local chemists, assuming the person behind the counter is a pharmacist, which is an incorrect assumption 10 times out of 10 in rural India.

“Anecdotally, this problem appears to be largely confined to small towns and rural India, but we see similar behavior even among people in big cities. The only difference is the quality of drug supply in smaller towns.

Other factors driving the trend are pressure from anxious parents and gaps in medical knowledge.

“Parents aren’t always well-informed and can become impatient. If a child’s cough or cold doesn’t improve within a few days, they often consult another doctor who will give them cough syrup,” says Dr. Khan.

Low knowledge among doctors adds to the problem. “I’ve seen even pediatricians prescribe Ambroxol cough syrup for children,” says Dr. Khan.

“It’s meant to break up phlegm, but two kids can’t keep themselves from spitting it out, so the mucus can be aspirated into the lungs and cause pneumonia, but it’s still prescribed.”

India needs a clear policy on cough syrups and national awareness among doctors and parents to curb reckless use. The stakes are real: Madhya Pradesh doctor prescribes syrup linked to recent child deaths defend his practice “I have been prescribing this cough syrup for 15 years.”