Low awareness of proper use of cold and cough medication among Czech paediatricians: a questionnaire study

Cough and cold medications (CCMs) are widely used in paediatric practice despite limited evidence of efficacy and concerns regarding safety in young children. This study aimed to evaluate Czech paediatricians' knowledge, attitudes, and recommendation practices related to CCMs and to identify factors associated with inappropriate use in children under 6 years of age. An anonymous questionnaire-based survey was distributed online to hospital paediatricians and general practitioners for children across the Czech Republic. The survey assessed demographic characteristics, patterns of CCMs use, knowledge of efficacy and safety, awareness of international recommendations, and attitudes toward potential restrictions and educational interventions. Associations were analysed using descriptive statistics, logistic regression, and Fisher's exact test where appropriate. Of 266 respondents, 74.1% reported using CCMs in children under 6 years and 40.6% in children under 2 years. Recommendation practices were not associated with age or postgraduate training but varied significantly by region and medical school attended. Reliance on international literature was associated with the lowest use of CCMs, whereas reliance on local sources or older colleagues predicted higher use. Lack of awareness of the unproven efficacy of CCMs, as well as recommendations from the American Academy of Pediatrics and Health Canada, were the strongest predictors of inappropriate recommendations. While knowledge of the Medicines and Healthcare products Regulatory Agency recommendation also showed association with a good recommendation practice, the association was not significant in the multivariable model.

Despite robust international guidance, CCMs remain commonly used in Czech paediatrics. Knowledge gaps, entrenched habits, and reliance on outdated information sources contribute to inappropriate use. Targeted educational initiatives and harmonised national guidelines are needed to improve practice.

● CCMs remain widely used in paediatrics despite limited efficacy and safety concerns in young children. ● International recommendations, including those from the AAP and Health Canada, advise against CCMs use in children under 6 years.

● In the Czech Republic, CCMs are used by 74% of paediatricians in children < 6 years and 41% in children < 2 years. ● CCMs recommendation practices vary by region and medical school, but not by age or training level. Higher inappropriate use is associated with reliance on local sources and older colleagues.