Physician Attitudes Toward Natural Syrup Formulations for Cough and Sore Throat: A Multinational Cross-Sectional Survey of 398 Healthcare Professionals Across 13 Countries

Abstract

Abstract Background: Understanding physician attitudes toward natural over the counter (OTC) products in respiratory medicine remains understudied in multinational contexts. This study represents the first systematic multinational surveyevaluation of physician perceptions regarding natural syrup formulations for cough and sore throat management. Objective: To assess physician acceptance of a natural syrup containing Verbascum and Malva sylvestris extracts across diverse international healthcare settings by evaluating seven key product attributes. Methods: Cross-sectional survey of 398 practicing physicians across 13 countries was conducted through the Sermo global physician network in May 2025. Participants evaluated clinical appropriateness, safety in vulnerable populations, co-prescription capabilities, throat protection properties, allergen-free composition, natural ingredient preference, and nighttime convenience compared to the leading lozenge in each country. Results: while regional variations were observed, overall physician acceptance was highest for absence of problematic pharmaceutical ingredients (86%), followed by safety in vulnerable populations and co-prescription safety (82%), with lower agreement for natural ingredients (77%), throat protection (73%), allergen-free composition (71%), and night-time convenience (63%). Regional patterns showed consistently higher acceptance in Middle Eastern countries and below-average values in most European countries (except Ireland), with Saudi Arabia highest and Finland and Italy lowest. Conclusions: Physicians across diverse healthcare systems reported favourable attitudes toward this natural syrup formulation, with particular emphasis on the perceived safety profile for vulnerable patient groups.show strong support for natural respiratory therapies, with particular emphasis on safety for vulnerable patient groups. The notable international variation underscores suggests the potential influence of cultural and regional factors on prescribing practicesattitudes. While these exploratory findings should be interpreted cautiously given the descriptive study design and industry sponsorship, they provide preliminary support for the continued investigation of natural formulations in respiratory care, particularly for patients with comorbidities who may require alternatives to conventional antitussive therapies.These results support the ongoing development of evidence-based natural products and highlight the growing integration of botanical medicines into modern respiratory care, especially for patients with comorbidities who require safer therapeutic options.