Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis

BMJ Evid Based Med. 2021 Apr;26(2):57-64. doi: 10.1136/bmjebm-2020-111336. Epub 2020 Aug 18.


Background: Antibiotic over prescription for upper respiratory tract infections (URTIs) in primary care exacerbates antimicrobial resistance. There is a need for effective alternatives to antibiotic prescribing. Honey is a lay remedy for URTIs, and has an emerging evidence base for its use. Honey has antimicrobial properties, and guidelines recommended honey for acute cough in children.

Objectives: To evaluate the effectiveness of honey for symptomatic relief in URTIs.

Methods: A systematic review and meta-analysis. We searched Pubmed, Embase, Web of Science, AMED, Cab abstracts, Cochrane Library, LILACS, and CINAHL with a combination of keywords and MeSH terms.

Results: We identified 1345 unique records, and 14 studies were included. Overall risk of bias was moderate. Compared with usual care, honey improved combined symptom score (three studies, mean difference -3.96, 95% CI -5.42 to -2.51, I2=0%), cough frequency (eight studies, standardised mean difference (SMD) -0.36, 95% CI -0.50 to -0.21, I2=0%) and cough severity (five studies, SMD -0.44, 95% CI -0.64 to -0.25, I2=20%). We combined two studies comparing honey with placebo for relieving combined symptoms (SMD -0.63, 95% CI -1.44 to 0.18, I2=91%).

Conclusions: Honey was superior to usual care for the improvement of symptoms of upper respiratory tract infections. It provides a widely available and cheap alternative to antibiotics. Honey could help efforts to slow the spread of antimicrobial resistance, but further high quality, placebo controlled trials are needed.

Prospero registration no: Study ID, CRD42017067582 on PROSPERO: International prospective register of systematic reviews (https://www.crd.york.ac.uk/prospero/).

Keywords: general practice; public health.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Cough / drug therapy
  • Honey*
  • Humans
  • Respiratory Tract Infections* / drug therapy


  • Anti-Bacterial Agents