Honey Should be a First Resort for Coughs, NICE advises

Peter Russell

August 23, 2018


Taking honey and over-the-counter medication as a first line treatment for a cough feature in guidance issued this week by the National Institute for Health and Care Excellence (NICE).

With the approach of autumn, guidance also covers increasing the uptake of the influenza vaccine among eligible groups, as well as for health and care workers.

Our roundup also covers announcements on treatments for enlarged prostate, neuroblastoma, and psoriatic arthritis.

Honey for Coughs

Honey, or cough medicines containing pelargonium, guaifenesin, or dextromethorphan, may relieve cough symptoms and should be tried before seeking medical advice, according to draft guidelines.

Clinicians should not offer antibiotics, as they make little difference to a patient's symptoms in cases of cold, flu, or bronchitis.

"When prescribing antibiotics, it is essential to take into account the benefit to the patient and wider implications of antimicrobial resistance," said Professor Mark Baker, director of the centre for guidelines at NICE.

Ablative Water Vapour Thermotherapy for Benign Prostate Hypertrophy

A form of steam treatment – transurethral water vapour ablation – to reduce the size of an enlarged prostate was approved for routine NHS use.

The technique involves inserting a retractable needle into the prostate to deliver bursts of steam at approximately 103C. The heat disrupts cell membranes in the prostate, leading to rapid cell death, and a reduction in prostate size.

The treatment could offer an alternative to surgery, and with fewer side-effects, NICE said in final guidance.

Sexual Health

People who contact a sexual health service should be given an appointment within 48 hours to help reduce sexually transmitted infections (STIs), a draft quality standard said.

It also said people who are diagnosed with a STI should be helped to notify their partners.

Also, men who have sex with men should be tested every 3 months if they are at increased risk of STIs.

Boosting the Uptake of Flu Vaccination

Health and social care staff should concentrate on educating eligible people about the importance of receiving an annual flu vaccination, final NICE guidance said.

The advice should highlight that people in certain groups, such as pregnant women, are entitled to receive the vaccine free of charge.

The guideline also set out a strategy to increase the number of front-line health and social care staff having the flu vaccine to protect themselves, their families, and the people they care for.

Dinutuximab Beta for Treating Neuroblastoma

NICE recommended dinutuximab beta (Qarziba, EUSA Pharma) as a second-line treatment option for high-risk neuroblastoma in people aged 12 months and over.

The monoclonal antibody works by binding to GD2, a glycolipid, which is present on the surface of neuroblastoma cells, but not normal cells. When dinutuximab beta attaches to the neuroblastoma cells, it makes them a target for the body’s immune system, which then kills the cancer cells.

Final guidance said although the medication did not meet NICE's usual criteria, it had taken into account various factors, including the rarity and severity of the disease, and the manufacturer's discount on the price.

Treatment of Myeloid Leukaemia

Liposomal cytarabine (DepoCyt, Skye Pharma) and daunorubicin (Cerubidine, West-Ward Pharmaceutical) were not recommended for treating newly diagnosed, therapy-related acute myeloid leukaemia or acute myeloid leukaemia with myelodysplasia-related changes in adults.

Cost-effectiveness estimates were above the normally acceptable range, NICE said in an appraisal consultation document.

A final appraisal is due to be published in January 2019.

Treatment for Psoriatic Arthritis

Tofacitinib (Xeljanz, Pfizer) in combination with methotrexate, was recommended as an option for treating active psoriatic arthritis in adults, NICE said in final draft guidance.

The guidance laid down certain conditions for patient eligibility and the manufacturer to supply the medication at an agreed discount.

A final appraisal is due to be published in December 2018.

Cabozantinib for Renal Cell Carcinoma

Cabozantinib (Cabometyx, Ipsen) was recommended for adults with untreated advanced renal cell carcinoma that is intermediate or poor risk.

The NICE appraisal said that clinical trial evidence showed that cabozantinib delays cancer progression, although it remained unclear how much extra benefit it might offer compared with other treatments.

The final draft technology appraisal said cabozantinib was recommended on the condition that the manufacturer supplied it at an agreed discounted price.

This article was updated after publication to include the embargoed cabozantinib guidance.


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