D1.403 - Use of ketotifen as treatment for post viral infection cough in children

Cough following viral infections in children is common varying significantly based on the child's age,  type of virus, and child's underlying health status. After onset of a viral infection as acute symptoms subside, an unremittent cough may occur. Ketotifen is a non-competitive H1 antihistamine which is mildly sedating with some properties of first generation antihistamines and a mast cell stabilizer. Before second generation antihistamines (SGAH) became available it was prescribed as a first line of drug in children with “asthmatic cough”. The aim of our study was to summarize experience on prescribing ketotifen to children with post viral cough.

For this real life database study, a search was done of  the medical records of children visiting two outpatient offices in Sofia, Bulgaria during the fall-and-winter season of 2023/24, who presented initially with a diagnosis “Acute Respiratory infection, unspecified (ICD-10: J06.9), and who revisited 2 or more times with “Cough, unspecified” (ICD-10: R05.9).  At visit 2, having confirmed that there were no more symptoms of florid infection or asthma, a discussion occurred with the parents  regarding cough management options including the pros and cons of prescribing ketotifen or SGAHs (loratadine/desloratadine, cetirizine/levocetirizine, bilastine, rupatadine) at approved doses. Both children and parents were asked to rate the respective drug’s anti-tussive effect using a traditional Bulgarian 6 grade scale on prescription day and after completion of treatment.

55 children were identified who met the above criteria, for whom 30 were prescribed ketotifen.  Among these, 23 (10 girls; 13 on ketotifen) were preschool (4-6yrs); 20 (12 girls;  10 on ketotifen) were school aged children (7-12yrs); and 12 (7 girls;  7 on ketotifen) were teenagers. The children on ketotifen improved their initial cough score by 3.6 points, compared to 2.5 points for the ones on SGAH ( P-value of 0.004). The younger children tended to respond better to ketotifen.

Ketotifen may offer specific advantages in treating cough, especially when allergic or inflammatory components are involved. SGAH have advantages however based on less sedation and adverse effects. The choice between ketotifen and SGAH  for post viral cough should be guided by the patient's specific symptoms, underlying conditions, and overall treatment goals.