The Central Drugs Standard Control Organisation (CDSCO) has initiated risk-based inspections of drug manufacturing units in six states—Himachal Pradesh, Uttarakhand, Gujarat, Tamil Nadu, Madhya Pradesh, and Maharashtra—after reports of child deaths in Madhya Pradesh and Rajasthan allegedly linked to contaminated cough syrups.
The inspections, which began on Friday, cover 19 samples including cough syrups, antipyretics, and antibiotics. Officials from the Health Ministry said the aim is to identify gaps in drug manufacturing processes that could have led to quality failures and recommend improvements to prevent future incidents.
A multidisciplinary team comprising experts from the National Institute of Virology, Indian Council of Medical Research, National Environmental Engineering Research Institute, CDSCO, and AIIMS-Nagpur is analysing the samples to determine the cause of deaths in and around Chhindwara, Madhya Pradesh.
So far, six samples tested by CDSCO and three by the Madhya Pradesh Food and Drugs Administration (MPFDA) were found free of Diethylene Glycol (DEG) and Ethylene Glycol (EG), chemicals known to cause kidney damage. However, the tested samples did not include the two suspected cough syrups, including ‘Coldrif,’ which remain under scrutiny.
In response to the Union Health Ministry’s advisory directing that cough and cold medications should not be prescribed to children under two years of age, the Indian Academy of Paediatrics (IAP), Nagaland State Branch, led by President Dr Akumtoshi, issued public safety guidelines for parents and healthcare providers.
The IAP Nagaland cautioned that combination cough and cold syrups must not be given to children below two years of age, and urged parents to avoid using such medications without a doctor’s prescription. It further clarified that combination syrups should only be prescribed after proper clinical evaluation and strictly according to recommended dosages.
The statement advised parents and healthcare providers to use bronchodilators and mucolytics judiciously.
“In children with cough due to bronchospasm, asthma, or wheezing disorders, bronchodilators such as salbutamol or levosalbutamol may be used — preferably through inhalation under medical supervision,” it said.
It added that mucolytics or expectorants such as ambroxol, bromhexine, or acetylcysteine may be considered in selected cases with thick sputum, but only under paediatric guidance.
Paediatricians stressed that routine or unsupervised use of these medications is not recommended, particularly in infants and toddlers. Antihistamines, they noted, may be considered in children above six months for specific conditions like allergic rhinitis, but should not be used routinely for simple coughs or colds.
The IAP reiterated that Over-The-Counter (OTC) cough syrups should be strictly avoided without medical consultation, as such medications can be dangerous for vulnerable groups, including infants, children, and lactating mothers.
Instead, it recommended adequate hydration, rest, saline nasal drops, and supportive home care as the safest and most effective first-line management for most childhood coughs and colds.
Currently, around 30 paediatricians are practising across different parts of Nagaland, according to IAP Nagaland.
The advisory from the Directorate General of Health Services (DGHS) followed reports of child deaths allegedly linked to contaminated cough syrups in Madhya Pradesh and Rajasthan. The Central Drugs Standard Control Organisation (CDSCO) has since initiated risk-based inspections of drug manufacturing units in six states.
The Tamil Nadu government has also banned the sale of the ‘Coldrif’ cough syrup after sample tests. However, uncertainty remains regarding the sale or availability of contaminated or unsafe cough syrups in Nagaland.
IAP Nagaland: Key Safety Guidelines
·Avoid giving OTC cough syrups without medical consultation
·Use bronchodilators and mucolytics judiciously
·Do not give medicines without a doctor’s advice
·Avoid routine use of antihistamines for simple coughs or colds
·First-line care: hydration, rest, saline nasal drops, and supportive home care
