Effectiveness of an Herbal Preparation Containing Echinacea, Propolis, and Vitamin C in Preventing Respiratory Tract Infections in Children

Cohen, Herman Avner; Varsano, Itzchak; Kahan, Ernesto; Sarrell, E. Michael; Uziel, Yosef

doi:10.1001/archpedi.158.3.217

Cited by 122 publications

(124 citation statements)

References 29 publications

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Section: Evidence Profile 10a: Secondhand Smokementioning

confidence: 99%

“…A single recent trial indicated that an herbal preparation containing Echinacea, propolis, and vitamin C prevented the development of upper respiratory infections in children between the ages of 1 and 5 years. 166 Bronchiolitis was not specifically studied.To date, there are no studies that conclusively show a beneficial effect of alternative therapies used for the treatment of bronchiolitis. Recent interest in the use of CAM has led to research efforts to investigate its efficacy.…”

mentioning

confidence: 99%

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Diagnosis and Management of Bronchiolitis

2006

Pediatrics

885

293

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Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm.The American Academy of Pediatrics convened a committee composed of primary care physicians and specialists in the fields of pulmonology, infectious disease, emergency medicine, epidemiology, and medical informatics. The committee partnered with the Agency for Healthcare Research and Quality and the RTI International-University of North Carolina Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to the diagnosis, management, and prevention of bronchiolitis. The resulting evidence report and other sources of data were used to formulate clinical practice guideline recommendations.This guideline addresses the diagnosis of bronchiolitis as well as various therapeutic interventions including bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physiotherapy, and oxygen. Recommendations are made for prevention of respiratory syncytial virus infection with palivizumab and the control of nosocomial spread of infection. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent comprehensive peer review before it was approved by the American Academy of Pediatrics.This clinical practice guideline is not intended as a sole source of guidance in the management of children with bronchiolitis. Rather, it is intended to assist clinicians in decision-making. It is not intended to replace clinical judgment or establish a protocol for the care of all children with this condition. These recommendations may not provide the only appropriate approach to the management of children with bronchiolitis. INTRODUCTIONTHIS GUIDELINE EXAMINES the published evidence on diagnosis and acute management of the child with bronchiolitis in both outpatient and hospital settings, including the roles of supportive therapy, oxygen, bronchodilators, antiinflammatory agents, antibacterial agents, and antiviral agents and make recommendations to influence clinician behavior on the basis of the evidence. Methods of prevention All clinical practice guidelines from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of care. Variations, taking into account individual circumstances, may be appropriate. Key Word bronchiolitisAbbreviations CAM-complementary and alternative medicine LRTI-lower respiratory tract infection AHRQ-Agency for Healthcare Research and Quality RSV-respiratory syncytial virus AAP-American Academy of Pediatrics AAFP-American Academy...

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Section: Evidence Profile 10a: Secondhand Smokementioning

confidence: 99%

mentioning

confidence: 99%

Diagnosis and Management of Bronchiolitis

2006

Pediatrics

885

293

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“…Several new trials of echinacea preparations in the prevention of the common cold have been completed since the Cochrane review, but most have not shown beneficial effects for echinacea preparations compared with placebo on main outcome measures (Melchart et al 1998;Grimm & Mu¨ller 1999;Turner et al 2000;Cohen et al 2004;Sperber et al 2004).…”

Section: Prophylaxis a Cochrane Systematic Review Included 16mentioning

confidence: 99%

“…, propolis 50 mg mL À1 and vitamin C 10 mg mL À1 in children (Cohen et al 2004). In this randomized, double-blind study, 430 children, aged 1 to 5 years, received 5 mL of the preparation (7.5 mL for children aged 4 to 5 years), or placebo, twice daily for 12 weeks over a winter period.…”

mentioning

confidence: 99%

Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt., Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties

Barnes

Anderson²,

Gibbons

et al. 2005

Journal of Pharmacy and Pharmacology

379

310

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This paper reviews the chemistry, pharmacology and clinical properties of Echinacea species used medicinally. The Echinacea species Echinacea angustifolia, Echinacea pallida and Echinacea purpurea have a long history of medicinal use for a variety of conditions, particularly infections, and today echinacea products are among the best-selling herbal preparations in several developed countries. Modern interest in echinacea is focused on its immunomodulatory effects, particularly in the prevention and treatment of upper respiratory tract infections. The chemistry of Echinacea species is well documented, and several groups of constituents, including alkamides and caffeic acid derivatives, are considered important for activity. There are, however, differences in the constituent profile of the three species. Commercial echinacea samples and marketed echinacea products may contain one or more of the three species, and analysis of samples of raw material and products has shown that some do not meet recognized standards for pharmaceutical quality. Evidence from preclinical studies supports some of the traditional and modern uses for echinacea, particularly the reputed immunostimulant (or immunomodulatory) properties. Several, but not all, clinical trials of echinacea preparations have reported effects superior to those of placebo in the prevention and treatment of upper respiratory tract infections. However, evidence of efficacy is not definitive as studies have included different patient groups and tested various different preparations and dosage regimens of echinacea. On the basis of the available limited safety data, echinacea appears to be well tolerated. However, further investigation and surveillance are required to establish the safety profiles of different echinacea preparations. Safety issues include the possibility of allergic reactions, the use of echinacea by patients with autoimmune diseases and the potential for echinacea preparations to interact with conventional medicines.

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“…Treatment with Echinacea was associated with increased risk of rash compared with placebo group (Taylor et al, 2003). In other study treatment with extract of Echinacea, vitamin C and propolis reduced significantly number and duration of illness episodes in children when compared with placebo treated group (Cohen et al, 2004). Several meta-analysis were performed with great heterogeneity of trials and results suggest that Echinacea extracts might have beneficial effect in the early treatment of common colds, but the there was insufficient evidence to suggest an effect on prevention (Gilles et al, 2000 Linde et al, 2006 Shah et al, 2007.…”

Section: Wwwintechopencommentioning

confidence: 83%