UK Guidelines Recommend Honey, Not Antibiotics, for Cough

Analysis by Dr. Joseph Mercola Fact Checked

• June 19, 2023

Story at-a-glance

• With the goal of reducing inappropriate antibiotic use by half by 2021, the U.K. Department of Health has proposed guidelines recommending the use of honey as a first line of treatment for coughs
• Antibiotics do little to improve colds and flu or symptoms like coughs and sore throat because they are not designed to treat viral infections, which typically run their course within a week or two
• The antibacterial, anti-inflammatory and antioxidant properties of honey are well-known, making honey a great alternative to prescription drugs when treating coughs
• I highly recommend Manuka honey, which has a long history of use as a treatment for bacterial infections and wounds, making it a beneficial natural health remedy

Editor's Note: This article is a reprint. It was originally published September 10, 2018.

Given the growing concern about antibiotic resistance, it's no surprise the U.K. Department of Health has proposed guidelines recommending the use of honey and over-the-counter (OTC) remedies as the first line of treatment for coughs.

Antibiotics do little to improve colds and flu or symptoms like coughs and sore throat because they are not designed to treat viral infections. Viral infections typically run their course within a week or two.

The new recommendations are designed to support doctors toward the overall goal of prescribing less antibiotics. Given the skyrocketing rates of antibiotic resistance, which claims at least 700,000 lives worldwide annually, this type of public-safety measure makes sense — assuming it is well-enforced, and both doctors and patients embrace the new guidelines.

I agree honey is a great alternative to pharmaceutical drugs, as well as OTC medications. That said, be careful about the type of honey you choose. I recommend you use only raw organic honey for both medicinal and culinary purposes. For even better results, try Manuka honey, which has a long history of use for treating bacterial infections and inflammation.

UK Officials Advise Against Antibiotics for Coughs

As an offensive measure in the battle against antibiotic resistance, the U.K.'s National Institute for Health and Care Excellence (NICE) and Public Health England (PHE) suggest people with coughs should use honey and OTC medications as a first line of treatment.¹

Antibiotics, health officials say, should rarely be prescribed by doctors for coughs because generally they do little to improve symptoms. Dr. Susan Hopkins, deputy director of the national infection service at PHE, says "Antibiotic resistance is a huge problem, and we need to take action now to reduce antibiotic use ...

These new guidelines will support general practitioners (GPs) to reduce antibiotic prescriptions … [W]e encourage patients to take their GP's advice about self-care."² Hopkins was the keynote speaker at the 2018 NICE annual conference, where she shared the following facts about antibiotic resistance:³

• A failure to address the global problem of antibiotic resistance could result in 10 million deaths by 2050, at a cost of $86 trillion
• 1 in 3 patients in the hospital in England is on antibiotics at any given time
• 1 in 3 individuals living in England takes one course of antibiotics annually
• 74% of the antibiotics distributed in England are prescribed by GPs, while just 20% are administered through inpatient and outpatient hospital visits, 5% support dental procedures and 3% are given for other applications
• Championed by the national health service, the goal is to slash by half England's rates of inappropriate antibiotic prescribing by 2021

Antibiotics Are Overprescribed in the UK, Elsewhere

A 2014 study published in BMJ Open⁴ evaluated the prescribing practices at 568 GPs and found continued high rates of antibiotic administration to adults aged 18 to 59 who presented with a respiratory tract infection (RTI).

Specifically, the median practice prescribed antibiotics at 48% of the consultations for coughs and bronchitis, 60% for sore throats and 38% for colds and upper RTIs.

The study authors stated, "Most U.K. GPs prescribe antibiotics to young and middle-aged adults with respiratory infections at rates that are considerably in excess of what is clinically justified. This will fuel antibiotic resistance."⁵

In January 2018, NICE and PHE issued guidance on sore throats, illnesses that can be caused by either a bacterial or viral infection, suggesting doctors should only prescribe antibiotic drugs for severe cases that are likely to result from a bacterial infection.⁶

Professor Cliodna McNulty, clinical microbiologist and head of Gloucester PHE's primary care unit, said, "Antibiotics are a precious resource and it's important they are only used when really needed. For a sore throat, evidence shows antibiotics make little difference to [the] length or severity of [the] illness, unless [the] symptoms are much more severe."⁷

Professor Gillian Leng, deputy chief executive at NICE, stated, "[I]t is clear routine prescribing in all cases isn't appropriate. We are living in a world where bacteria are becoming resistant to antibiotics. It is vital these medicines are protected and only used when they are effective."⁸

The issues extend far beyond the U.K., as a 2016 JAMA study⁹ notes about one-third of antibiotic drugs prescribed in the U.S. are unnecessary. The World Health Organization (WHO) asserts:¹⁰

"Antibiotic resistance is one of the biggest threats to global health, food security and development today. [It] occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process.

The world urgently needs to change the way it prescribes and uses antibiotics. Even if new medicines are developed, without behavior change, antibiotic resistance will remain a major threat."

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How Big of an Issue Is Antibiotic Resistance?

The rates of infectious diseases known to be unresponsive to antibiotics continue to skyrocket. Drug-resistance and superbugs are serious issues that could have dire consequences on human health — including yours.

Infection-causing bacteria, fungi, parasites and viruses continue to evolve and resist the drugs meant to contain them. Antibiotic resistance is a hot topic because about 2 million Americans are diagnosed with drug-resistant infections annually and 23,000 die each year.¹¹

Similarly, drug-resistant infections kill 25,000 Europeans annually.¹² On the whole, at least 700,000 people worldwide die each year from drug resistance associated with illnesses such as AIDS, bacterial infections, HIV, malaria and tuberculosis (TB).¹³

Sadly, the numbers may be even higher since we lack a global reporting system. Furthermore, incident rates may not be consistently tracked in low-income areas or refugee camps where the spread of disease and infection can be rampant.

While you may not be able to control the spread of malaria or TB on a faraway continent, you can take responsibility for an aspect of drug resistance that is under your influence — prescription antibiotics requested by and dispensed personally to you, as well as the ones found in your food.

Antibiotic Use Increased by 39% in Just 15 Years

A study published in the journal Proceedings of the National Academy of Sciences USA,¹⁴ in which the human consumption of antibiotics was evaluated in 76 countries, indicates antibiotic use increased 39% from 2000 to 2015. Specifically, the researchers found:¹⁵

• For every 1,000 people, antibiotic consumption rates increased from 11.3 doses per day in 2000 to 15.7 does per day in 2015
• The use of broad-spectrum penicillins — the most common type of antibiotics — increased by 36%
• The most dramatic increase was noted in low- and middle-income countries (LMICs), where antibiotic use increased 114%
• Antibiotic use in high-income countries declined by 4%

The study authors noted increased rates of antibiotic use in LMICs may be a positive sign since lack of access traditionally has been a problem. They asserted, "Reducing global consumption is critical for reducing the threat of antibiotic resistance, but reduction efforts must balance access limitations in LMICs and take account of local and global resistance patterns."¹⁶

Another factor in the rise of antibiotic resistance centers around the fact fewer new drugs are being developed. According to The New York Times,¹⁷ the number of antibiotics approved by the U.S. Food and Drug Administration (FDA) has steadily declined the past two decades.

Most large pharmaceutical (Big Pharma) companies, including Pfizer, which was long known for its leadership in the development of antibiotics, have moved on to other more profitable drugs.

For example, drugs used in cancer treatment and diabetes are a source of profitability that life-saving antibiotics most likely will never be. The infrequency of antibiotic use is likely a significant factor in Big Pharma's waning interest in developing these drugs.

After all, it's harder to make money on drugs that are used only infrequently and may be used even less frequently in the future due to mounting concerns around antibiotic resistance.

Viral Illnesses Like Colds Do Not Require Antibiotics

PHE — one of the groups issuing the new guidance about coughs in the U.K. — says up to one-fifth of antibiotic prescriptions are written unnecessarily because most of the illnesses would heal on their own without drugs.¹⁸

Similarly, in the U.S. the problem of drug resistance centers around improper use of antibiotics, particularly to treat viral infections like the common cold or flu. About the overuse of antibiotics in the U.S., the Centers for Disease Control and Prevention (CDC) says:¹⁹

"Antibiotics are among the most commonly prescribed drugs used in human medicine and can be lifesaving drugs. However, up to 50 percent of the time, antibiotics are not optimally prescribed, often done so when not needed [and given with] incorrect dosing or duration."

In addition to the human aspects of antibiotic resistance, in the U.S. the long-standing practice of raising livestock in concentrated animal feeding operations (CAFOs), where they are fed low doses of antibiotics, enables pathogens to survive, adapt and eventually thrive.

The reality that nearly 80% of antibiotics administered in the U.S. go into farm animals has far-reaching implications to your health.

This startling figure should also give you a sense of why CAFOs are becoming increasingly more well-known for their role in spreading deadly antibiotic-resistant disease. If you need more convincing about the dangers of CAFOS, also known as factory farms, check out my The Truth About Factory Farms infographic.

Even though you may logically understand antibiotics have zero effect on viral infections, you may be among the group still insisting on a prescription for them. The truth is, under most conditions, your body will recover from a viral infection when the illness has run its course. Taking antibiotics for viral infections is both unnecessary and dangerous since it contributes to drug resistance.

Said professor Paul Cosford, director for health protection and medical director at PHE, "We don't often need antibiotics for common conditions. The fact is if you take an antibiotic when you don't need it then you're more likely to have an infection the antibiotics don't work for over the coming months."²⁰

With respect to infections your body can handle, Cosford recommends you get extra rest and drink plenty of fluids. His advice is sound because if you use even a single course of antibiotics a year, you are contributing to the development of drug resistance. For that reason, it is best to reserve these drugs for the treatment of bacterial infections only.

Dr. Tessa Lewis, chair of the NICE antimicrobial prescribing guideline group, recommends, "If someone has a runny nose, sore throat and cough, we would expect the cough to settle over two to three weeks and antibiotics are not needed. If the cough is getting worse … or the person feels very unwell or breathless then they would need to contact their GP."²¹

Health Benefits of Raw Honey Continue to Emerge

Given the many potential remedies U.K. health officials could suggest in lieu of antibiotic medications, honey is among the most natural and best. The health benefits of honey are increasingly coming to the forefront as the world desperately seeks alternatives to the dwindling supply of antibiotics.

About honey's medicinal promise, a group of Iranian researchers conducting a literature review in 2017 stated:²²

"Honey is one of the most appreciated and valued natural products introduced to humankind since ancient times. Honey is used not only as a nutritional product but also in health … The ingredients of honey have been reported to exert antioxidant, antimicrobial, anti-inflammatory, antiproliferative, anticancer and antimetastatic effects.

Many evidences suggest the use of honey in the control and treatment of wounds, diabetes mellitus, cancer, asthma and also cardiovascular, neurological and gastrointestinal diseases."

Given its many well-established health benefits, you most certainly can use honey as a remedy for viral infections antibiotics can't treat. Try honey first for colds and flu, as well as the symptoms like coughs and sore throat that accompany them.

Why Manuka Honey Is No. 1 for Medicinal Purposes

I caution you from purchasing honey from your local market unless you know the source and processing method. Store-bought honey is often ultrafiltered and may be adulterated with corn syrup, dextrose, glucose, sugar syrup or a similar product that is used to create "fake honey."

Raw organic honey is unique because it contains crude honey removed from beehive combs and is jarred as-is, with no added sugars or other ingredients. If you really want to maximize the antibacterial and anti-inflammatory benefits of raw organic honey, I recommend you choose Manuka honey.

Manuka honey, which hails from New Zealand, is more expensive and yet well worth the added cost given its significant health benefits. Manuka honey is named after the Manuka bush, from which bees gather the nectar and pollen used to make this monofloral honey.

According to Manuka Honey Organic,²³ it's the Unique Manuka Factor (UMF)²⁴ — a grading system using a 5- to 26-point scale to measure the antibacterial strength of each batch — that sets Manuka apart from other types of honey. The UMF score is calculated based on the levels of three compounds found in Manuka honey:

• Docosahexaenoic acid (DHA) — a type of omega-3 fatty acid
• Leptosperin — a nectar from the manuka bush
• Methylglyoxal — an antibacterial component

The higher the UMF number, the greater the honey's antibacterial properties, which explains why manuka honey has been used to treat bed sores, burns, cuts and wounds, says registered dietitian and nutritionist Frances Largeman-Roth, former food and nutrition director at Health magazine.²⁵

She notes Manuka honey with a UMF content of 12 or higher is considered medical grade and can be added to bandages to treat burns and wounds.

Given the strong endorsement public health officials have given it, perhaps it's time to consider making raw organic honey your first line of defense for coughs and other cold and flu symptoms. For a DIY honey-based cough syrup, try the National Honey Board recipe below:

DIY Honey Cough Syrup²⁶

Ingredients

• Zest of 2 lemons (approximately 1 1/2 tablespoons)
• 1/4 cup ginger, peeled, sliced, or 1/2 teaspoon of ground ginger
• 1 cup water
• 1 cup (raw, organic or Manuka) honey
• 1/2 cup lemon juice

Directions

1. In a small saucepan, combine lemon zest, sliced ginger and 1 cup of water. Bring mixture to a boil, simmer for five minutes, then strain through into a heatproof measuring cup.
2. Rinse the saucepan out and pour in 1 cup of honey. On low heat, warm the honey, but do not allow it to boil. Add the strained lemon ginger water and the lemon juice. Stir the mixture until it combines to form a thick syrup.
3. Pour into a clean jar with a lid. This can be refrigerated for up to two months.

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