Table 3.
Summary of findings.
| Outcomes | Intervention/Comparison (number of participants) | Effect estimate (95% CI) | Certainty* | |
|---|---|---|---|---|
| Adults admitted to hospital for management of SARS-CoV-2 infection | ||||
| Critically important outcomes | ||||
| Risk of death for up to 28 days | 1 RCT29 | Propolis + usual care (n = 82) vs. usual care (n = 42) | No deaths (estimate of effect not estimable) | VERY LOWa,dd |
| Risk of shock requiring vasoactive drugs | 1 RCT29 | Propolis + usual care (n = 82) vs. usual care (n = 42) | RR 0.36 (0.15 to 0.87) 15 per 100 adults fewer (30 fewer to 1 fewer) | LOWa,d |
| Risk of respiratory failure requiring ventilation | 1 RCT29 | Propolis + usual care (n = 82) vs. usual care (n = 42) | RR 0.32 (0.11 to 0.92) 13 per 100 adults fewer (26 fewer to none fewer) | LOWa,d |
| Risk of acute kidney injury | 1 RCT29 | Propolis + usual care (n = 82) vs. usual care (n = 42) | RR 0.36 (0.15 to 0.87) 15 per 100 adults fewer (30 fewer to 1 fewer) | LOWa,d |
| Important outcomes | ||||
| Duration of oxygen therapy | 1 RCT29 | Propolis + usual care (n = 82) vs. usual care (n = 42) | MD -1.83 days (-4.82 to 1.16) | LOWa,d |
| Risk of requiring renal replacement therapy | 1 RCT29 | Propolis + usual care (n = 82) vs. usual care (n = 42) | RR 0.17 (0.02 to 1.59) 6 per 100 adults fewer (14 fewer to 2 more) | LOWa,d |
| Risk of admission to intensive care unit | 1 RCT29 | Propolis + usual care (n = 82) vs. usual care (n = 42) | RR 0.36 (0.12 to 1.05) 17 per 100 adults fewer (38 fewer to 3 more) | LOWa,d |
| Duration of hospital admission | 1 RCT29 | Propolis + usual care (n = 82) vs. usual care (n = 42) | MD -3.77 days (-6.14 to -1.39) | MODERATEa |
| Risk of non-serious adverse events | 1 RCT29 | Propolis + usual care (n = 82) vs. usual care (n = 42) | RR 0.26 (0.02 to 2.74) 4 per 100 adults fewer (10 fewer to 3 more) | VERY LOWaa,d |
| Adults in community settings with symptoms consistent with a non-specific viral RTI | ||||
| Critically important outcomes | ||||
| Likelihood of recovery within 5 days from acute pharyngitis/tonsilitis | 1 RCT36 | Honey + usual care (n = 45) vs. usual care (n = 38) | RR 1.20 (0.87 to 1.65) 8 per 100 adults more (6 fewer to 23 more) | VERY LOWaa,d |
| Acute RTI cough severity 1 hour after intervention | 1 RCT37 | Honey (n = 102) vs. placebo (n = 54) | MD 0.10 points (-0.08 to 0.28) | VERY LOWaa,d |
| 1 RCT37 | Honey (n = 102) vs. guaifenesin (n = 107) | MD 0.20 points (0.05 to 0.35) Favors Guaifenesin | VERY LOWaa,d | |
| Severity of persistent post-infectious cough | 1 RCT35 | Honey (n = 12) vs. coffee (n = 14) | MD -0.40 points (-0.75 to -0.05) | VERY LOWaa,d |
| 1 RCT35 | Honey + coffee (n = 48) vs. coffee (n = 14) | MD -1.40 points (-1.67 to -1.13) | LOWaa | |
| Important outcomes | ||||
| Risk of hospital admission for acute pharyngitis/tonsilitis | 1 RCT36 | Honey + usual care (n = 91) vs. usual care (n = 92) | RR 0.81 (0.22 to 2.92) 1 per 100 adults fewer (7 fewer to 5 more) | VERY LOWaa,d |
| Risk of non-serious adverse events | 1 RCT36 | Honey (n = 102) vs. placebo (n = 55) | RR 0.53 (0.11 to 2.58) 3 per 100 adults fewer (9 fewer to 4 more) | VERY LOWaa,d |
| 1 RCT36 | Honey + usual care (n = 91) vs. usual care (n = 92) | No adverse events (estimate of effect not estimable) | VERY LOWaa,d | |
| 1 RCT37 | Honey (n = 102) vs. guaifenesin (n = 107) | RR 0.79 (0.18 to 3.43) 1 per 100 children fewer (6 fewer to 4 more) | VERY LOWaa,d | |
| Children in community settings with symptoms consistent with a non-specific acute viral RTI | ||||
| Critically important outcomes | ||||
| Duration of acute cough | 1 RCT34 | Honey (n = 57) vs. placebo (n = 45) | MD -0.71 days (-1.15 to -0.28) | LOWaa |
| 1 RCT34 | Honey (n = 57) vs. salbutamol (n = 43) | MD -0.54 days (-0.99 to -0.09) | LOWaa | |
| Acute cough severity on day 1 | 2 RCT32,33 | Honey ± usual care (n = 68) vs. usual care (n = 71) | SMD -1.10 (-2.52 to 0.33) | VERY LOWaa,b,d |
| 3 RCT30,32,33 4 arms | Honey + usual care (n=135) vs. DXM or DHM + usual care (n=123) | SMD -0.65 (-0.97 to -0.32) | VERY LOWaa,d | |
| Important outcomes | ||||
| Global impact of nocturnal cough after 1 night | 1 RCT32 | Honey ± usual care (n = 35) vs. usual care (n = 37) | SMD -0.80 (-1.28 to -0.32) | VERY LOWaa,d |
| 3 RCT30, 31, 32 | Honey ± usual care (n = 301) vs. DXM, DHM or date extract ± usual care (n = 124) | SMD -0.74 (-1.18 to -0.30 | LOWaa | |
| Risk of vomiting as an adverse event | 1 RCT34 | Honey (n = 57) vs. placebo (n = 45) | RR 1.48 (0.69 to 3.18) 9 per 100 children more (7 fewer to 25 more) | LOWaa |
| Risk of any non-serious adverse event | 2 RCT32,33 | Honey ± usual care (n = 61) vs. usual care (n = 69) | RR 1.98 (0.40 to 9.87) 8 per 100 children more (11 fewer to 27 more) | VERY LOWaa,d |
| 4 RCT30, 31, 32, 33 | Honey + usual care (n = 332) vs. DXM, DHM or date extract + usual care (n = 194) | RR 1.57 (0.57 to 4.31) 1 per 100 children more (2 fewer to 4 more) | VERY LOWaa,d | |
⁎
GRADE 24 certainty (quality) assessments
a
serious risk of bias.
aa
very serious risk of bias.
b
serious inconsistency; bbvery serious inconsistency; cserious indirectness; ccvery serious indirectness.
d
serious imprecision.
dd
very serious imprecision; epublication bias strongly suspected. Further details of risk of bias are reported in Supplementary 5. The results of statistical tests for heterogeneity, and subgroup and sensitivity analyses are reported in Supplementary material. CI, Confidence interval; MD, Mean difference; RCT, Randomized controlled trial; RD, Risk difference / absolute relative risk; RR, Relative risk; RTI, Respiratory tract infection; SMD, Standard Mean Difference.