Recent studies have suggested that cough syrup -- usually containing the cough suppressant dextromethorphan and the expectorant guaifenesin -- works no better than sugar water.

In new guidelines for treating coughs, the American College of Chest Physicians advised dropping cough syrup and instead relying on familiar, low-cost antihistamines against coughs caused by simple upper respiratory tract infections.

"Cough syrups may suppress a cough a little bit. But they don't treat the underlying cause," said Dr. Michael Alberts, a Tampa pulmonologist who is president of the physician group. "They won't make you better any faster."

Another option that some doctors recommend: Just tough it out, because colds typically go away on their own.

No Better Than Sugar Water

Americans buy about $2.9 billion worth of over-the-counter cold medicine and another $400 million of prescription cold medication, a university study found in 2003. About $270 million goes for cough syrup, which generally sells for a few dollars a bottle.

Recent studies have suggested that cough syrup -- usually containing the cough suppressant dextromethorphan and the expectorant guaifenesin -- works no better than sugar water. A small Pennsylvania study of 100 children in 2004 and a British analysis of adult studies in 2002 reached the same conclusion.

In drafting its new guidelines coming out Tuesday in the journal Chest, the physicians group looked at the research and concluded that cough syrup can give short-term relief for some people -- such as helping them fall asleep -- but that's about all, Alberts said.

"This may be a little bit surprising to some people. Everyone has taken cough syrup. But that's why medical research continues to be done," Alberts said.

Dextromethorphan Can Be Abused

The group recommends using older-generation antihistamines that may attack the nasal drip and runny nose that cause many coughs. This includes drugs like Dristan and Tylenol Severe Allergy. Newer, expensive antihistamines do not help a cough, the group said. This includes Allegra, Claritin and Zyrtec.

Also, dextromethorphan has been abused and can lead to death, brain damage or heart trouble in extreme doses.

Some doctors still have confidence in cough syrup, saying it helps some patients.

"I have no problem using it," said Dr. Stephen Geller, a Coral Springs, Fla., ears, nose and throat specialist. "If they have an upper respiratory tract infection, it can relieve their symptoms."

The key, Geller said, is to examine the patient first and make sure the cough does not stem from something more serious, such as bronchitis, asthma or tobacco smoke.

Contrary to Experience?

Wyeth Consumer Healthcare, which makes Robitussin cough syrups, was surprised by the group's recommendations and called them contrary to decades of experience.

"They're really talking about dextromethorphan and guaifenesin. Both have been found to be safe and effective by the FDA. These products have a long history. Unless they worked, consumers would not be so loyal to them," said company spokesman Fran Sullivan.