No toxins found in cough syrup samples linked to deaths in Rajasthan, Madhya Pradesh: Centre

The Union Health Ministry on Friday confirmed that cough syrup samples linked to the deaths of children in Rajasthan and Madhya Pradesh did not contain toxins associated with kidney injuries.

As per the test results, none of the samples contained diethylene glycol (DEG) or ethylene glycol (EG), contaminants that are known to be illegally used as a cheap substitute for safe pharmaceutical solvents like glycerin in cough syrup and can cause serious kidney injury. The Madhya Pradesh State Food and Drug Administration (SFDA) also tested three samples and confirmed the absence of DEG/EG.

A joint team consisting of representatives from National Centre for Disease Control (NCDC), National Institute of Virology (NIV), Central Drugs Standard Control Organisation (CDSCO), visited the site.

Officials from the health ministry said that several samples of cough syrups, water were collected in coordination with the Madhya Pradesh health authorities.

After nine children died of kidney failure in Chhindwara in the last 15 days, the health authorities from Centre and State swung into action. Initial inquiries suggested the cough syrup had been laced with diethylene glycol.

“Further blood/or cerebrospinal fluid (a fluid that protects the brain and spinal cord) samples have been tested by the National Institute of Virology (NIV), Pune, for common pathogens. One case has been found positive for leptospirosis. Samples of water, entomological vectors, and respiratory specimens are under further investigation by NEERI, NIV Pune, and other laboratories,” the ministry said in a statement.

Officials said that a multi-disciplinary team comprising experts from NCDC, NIV, ICMR, AIIMS Nagpur, and state health authorities is investigating all possible causes behind the reported cases.

“As regards the reports related to two deaths of children in Rajasthan because of contaminated cough syrup consumption, it has been clarified that the product in question does not contain propylene glycol, which can be potential source of contaminants. Additionally, the product under reference is a dextromethorphan-based formulation, which is not recommended for paediatric use,” ministry informed.

Director General of Health Services (DGHS) has issued an advisory to all states and Union Territories on rational use of cough syrups in paediatric population.

DGHS Sunita Sharma said that most acute cough illnesses in children are self-limiting and often resolve without pharmacological intervention.

“Cough and cold medications should not be prescribed or dispensed to children under 2 years; they are generally not recommended for children under 5 years of age either. 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. Further, the public may also be sensitised regarding adherence to prescription by doctors,” the advisory said.

“Non-pharmacological measures, including adequate hydration, rest, and supportive measures should be the first-line approach. Sensitisation of prescribers and dispensers across public and private sectors is essential to uphold these standards of care,” states were directed by the DGHS.