Silent Poison: The Cough Syrup Tragedy in Madhya Pradesh

What Happened ?

In early October 2025, reports started emerging from Chhindwara district, Madhya Pradesh that multiple children under the age of five were dying from kidney failure following what appeared to be routine cold or cough symptoms. 

Governments and health authorities launched investigations. It was found that a cough syrup called Coldrif, manufactured by Sresan Pharmaceuticals in Tamil Nadu, was contaminated with diethylene glycol (DEG) — an industrial chemical that is extremely toxic to humans, especially children. 

Tests of the syrup revealed about 48.6% DEG in the sample — vastly exceeding safe allowable limits. 

The Toll

As of early October, 20 children have died in Madhya Pradesh while undergoing treatment for kidney failure linked to the contaminated syrup. 

Additional children are still hospitalized, some in critical condition. 

The children came from multiple districts (primarily Chhindwara, but also Betul, Pandhurna) and had initially presented with mild fever, cold, cough; after syrup use, they developed worsening symptoms like reduced urine output and kidney failure. 

Actions Taken

Authorities at state and national levels have responded in multiple ways:

Product ban & recall

The sale and distribution of Coldrif syrup has been banned in Madhya Pradesh since October 1, and all stocks are being seized. Also, the manufacturing facility in Tamil Nadu (Kancheepuram) of Sresan Pharmaceuticals has been sealed. 

Investigations & cases

A Special Investigation Team (SIT) has been formed to probe the manufacturing, regulation, prescribing, and distribution lapses. 

Legal action has been initiated against the manufacturer, the prescribing doctor (Dr. Praveen Soni), and officials from regulatory agencies for negligence. 

Drug inspectors, FDA (Food and Drug Administration) officials, and even the state drug controller have been suspended or transferred. 

Public health measures

ASHA (accredited social health activist) workers and anganwadi workers have been asked to go door-to-door to collect any potentially dangerous syrup bottles still in households. 

State-wide and multi-state checks are underway for other batches / brands of cough syrup. Other syrups (e.g., Respifresh TR and ReLife) are also being tested. 

Regulatory scrutiny

The tragedy has put medicinal regulation, oversight, manufacturing standards, and supply chains under strong scrutiny. The WHO has issued an alert. India’s CDSCO (Central Drugs Standard Control Organisation) is involved. 

Underlying Issues & Why This Happened

This tragedy, though horrifying, did not come from nowhere. There are systemic issues that likely contributed:

Poor quality control / adulteration

The presence of nearly 50% DEG points to gross negligence in the manufacturing or quality testing process. DEG is banned or highly restricted because it's known to cause acute kidney damage. 

Regulatory gaps

Either insufficient oversight, delayed testing, or lapses in enforcement. Some batches were distributed long before detection. The mechanisms to monitor hazardous substances likely failed.

Lack of awareness / prescription discipline

Some reports suggest these syrups were prescribed to very young children without sufficient caution. Also, over-the-counter and informal sale of cough syrups is common, increasing risk.

Supply chain issues

Once contaminated, medicines can spread widely unless recall is swift. Delays in removing stocks from markets, or in identifying all the batches/brands that are unsafe, worsen impact.

Accountability issues

From manufacturing to prescribing to regulatory approvals, multiple actors share responsibility — but if oversight/penalties are weak, bad actors may get away. Also, local health infrastructure may be under-resourced, making rapid detection harder.

What needs to change ?

To avoid future tragedies like this, several steps are essential:

Stronger Regulatory Oversight

Regular third‐party audits of drug manufacturing units.

Tightening of allowable chemical standards, especially for pediatric medications.

Better—faster lab testing for batches in circulation.

Transparent & Swift Recalls

Once a harmful batch is identified, there must be immediate recalls, wide public warnings, and removal of all stocks from markets, including small pharmacies and informal sellers.

Education and Awareness

Among healthcare providers: prescribing only necessary medicines, particularly for children.

Among parents: understanding risks, asking questions, storing and administering medicines responsibly.

Accountability & Justice

Full investigations not just into who prescribed or manufactured, but into regulatory failures. Brings those responsible to justice. Also ensuring victims’ families receive compensation, support.

Strengthening the Public Health Infrastructure

More resources to local laboratories, rapid response teams, disease surveillance units. Systems to detect anomalies early.

Policy Reforms

Possibly tighter rules around industrial-grade substances used in pharmaceuticals. More stringent import and use controls for toxic excipients. Regular updates in drug safety laws as science evolves.This incident isn’t isolated — similar tragedies have occurred in other countries due to contaminated medicines. What India is facing now should serve as a wake-up call not just nationally but globally. In a time when medicine supply chains are vast and complex, ensuring safety from raw materials to finished product is non-negotiable.

Also, measures in export regulation may be better established, but a huge domestic market often escapes sufficient scrutiny. Domestic drug regulation must be as robust as any international standard.

Lessons for India & beyond

This incident isn’t isolated — similar tragedies have occurred in other countries due to contaminated medicines. What India is facing now should serve as a wake-up call not just nationally but globally. In a time when medicine supply chains are vast and complex, ensuring safety from raw materials to finished product is non-negotiable.

Also, measures in export regulation may be better established, but a huge domestic market often escapes sufficient scrutiny. Domestic drug regulation must be as robust as any international standard.

Concluding Thoughts 

The deaths of 20 innocent children in Madhya Pradesh from a supposedly benign cough syrup are heartbreakingly tragic. They shine a harsh light on failures in manufacture, oversight, and public health. In these moments, governments and societies are judged not by how many lives they save in times of peace, but how thoroughly they protect the most vulnerable.

We owe it to those children to

 ensure that “never again” is more than a phrase; it must be a commitment — in policy, enforcement, awareness, and compassion.