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It’s cheap, readily available, and has virtually no side effects. Doctors can recommend it, finds research.

Honey is better than usual care for relieving the symptoms of upper respiratory tract symptoms, especially cough finds newly published research from the University of Oxford. The findings could aid efforts to slow the spread of antibiotic resistance.

The study, published today in BMJ Evidence Based Medicine, was a systematic review and meta-analysis – the yard-stick by which evidence in health sciences is measured – of 14 studies looking at the effectiveness of honey for URTIs.

Most Upper Respiratory Tract Infections (URTIs) are due to viral infection, and for otherwise healthy people URTIs tend to be self-limiting, getting better within 14 days or so without treatment. However, URTIs are a common reason for antibiotics to be prescribed, despite them making little difference to the severity of symptoms, since viruses are unaffected by antibiotics.

“With the global spectre of antibiotic resistance looming, new treatments for URTIs that are effective and that doctors can recommend now, are more important than ever,” said Hibatullah Abuelgasim, Oxford medical student, who completed the study as part of her third-year undergraduate medical student research project at the Nuffield Department of Primary Care Health Sciences.

The researchers analysed studies that compared the effect of taking honey, in forms such as teas, neat, or mixed with other ingredients, to either usual care – such as antibiotics, or over-the-counter cough syrups and medications – or medically inert placebos. Studies compared symptoms such as cough severity, cough frequency and symptom length.

They found that, compared to usual care, honey was associated with a significantly greater reduction in symptoms, specifically cough severity and frequency.

“Honey has long been known as a traditional treatment for URTI symptoms, such as coughs and sore throat,” said Dr Joseph Lee, researcher, beekeeper and GP, from Oxford University's Nuffield Department of Primary Care Health Sciences. “Since 2018 the National Institute for Health and Care Excellence (NICE) and Public Health England (PHE) have recommend the use of honey to treat the symptoms of acute coughs in adults and children five years or older. However, this is based on a review of just three randomised controlled trials. Our work adds to this evidence base and focuses specifically on URTIs.”

“Doctors often prescribe antibiotics for URTIs, even when they could be fairly certain they might offer no clinical benefit, often due to a lack of alternative treatments and an earnest desire to help patients feel better,” said Dr Charlotte Albury, Research Fellow in Health Behaviours and Teaching Lead in Qualitative Research Methods at the University of Oxford's Nuffield Department of Primary Care Health Sciences, “This research gives us good quality evidence that can help doctors be confident when suggesting people use honey.”

“Honey is cheap and widely available, many people will probably have some sitting in the cupboard anyway, so it’s worth giving it a try before visiting your GP,” said Dr Lee. “Of course, if symptoms are getting worse, or you feel very unwell, then contact your GP.”

The researchers did note that the risk of bias assessments of the studies they included in their analysis were variable; this affects the quality of the studies, and therefore the strength of the evidence. Another potential source of uncertainty is that ‘usual care’ and honey-containing interventions differed between studies. As such, the researchers say they support further trials, particularly addressing symptoms other than cough.