Evidence-based management of acute rhinosinusitis with herbal products

Abstract

Background The overuse of antibiotics for unjustified indications such as the management of acute uncomplicated rhinosinusitis has contributed to the emergence of antibiotic-resistant strains of bacteria and prompted the need for alternative treatments. This review assesses the quality of evidence for the management of acute rhinosinusitis with herbal products, with the goal of positioning them among other treatments and identifying future research directions. The MEDLINE database was searched for randomized controlled trials with Sinupret®, Pelargonium sidoides extract, Cyclamen europaeum (CE), cineole, and GeloMyrtol®. Searches with N-acetylcysteine and mometasone furoate nasal spray (MFNS) were performed to compare the strength of evidence of herbal products to these conventional products, which are indicated for acute rhinosinusitis. Main body Evidence was strongest for Sinupret, followed by Pelargonium sidoides extract. Their use in acute rhinosinusitis is supported by randomized placebo-controlled trials demonstrating both clinical efficacy and safety. Comparative data with conventional treatments such as topical glucocorticosteroids were found only for Sinupret and suggested comparable efficacy in a small study. For other herbal products, the overall level of evidence was low. The search retrieved two small-scale placebo-controlled randomized studies with CE nasal spray. The two trials were not powered to draw conclusions about the safety and efficacy of CE nasal spray and reported a lack of efficacy with CE on symptom reduction. Only one randomized placebo-controlled trial was identified for GeloMyrtol and cineole. These suggested an improvement in acute rhinosinusitis symptoms with both products, but the results warrant replication in larger trials. Studies directly comparing herbal products are scarce; one randomized trial has compared cineole with Sinupret, but the results need confirmation in further studies. Studies with N-acetylcysteine are limited to small-scale clinical trials, while MFNS is supported by a strength of evidence comparable to Sinupret in this indication. Conclusion State-of-the-art studies demonstrating the efficacy and safety of herbal products for the management of acute rhinosinusitis are available. Given that the evidence for Sinupret is the strongest and comparable to that of a widely available topical corticosteroid, MFNS, Sinupret may be considered for the management of acute uncomplicated rhinosinusitis.

Contribution of Symptomatic, Herbal Treatment Options to Antibiotic Stewardship and Microbiotic Health

“…While antibiotic treatment is common, respiratory infections also respond well to treatment with herbal combinations. A recent review affirmed the growing body of evidence for the effectiveness of herbal products as a treatment of acute rhinosinusitis [ 118 ], which is in line with findings from a real-world study that discussed herbal products as a viable alternative to antibiotics [ 119 ]. In addition, guidelines for acute and chronic cough suggest herbal products for uncomplicated respiratory infections, in combination with delayed prescription of antibiotics, i.e., patients could receive prescriptions for antibiotics with no further consultation, in case an infection persists, ultimately resulting in notably fewer patients who will take antibiotics, compared to a prescription at the first consultation [ 108 ].…”

In vitro Screening of Herbal Medicinal Products for Their Supportive Curing Potential in the Context of SARS-CoV-2

“…Besides, they have been reported to exhibit an anti-inflammatory and immune-modulating potential and thus may also be supportive in preventing or attenuating mild to moderate SARS-CoV-2 infections [ 4 – 6 ]. In this pilot screening study, five herbal medicinal products, marketed for the treatment of respiratory infections [ 5 – 8 ], were explored for their potential to (i) interfere with the binding of the human angiotensin-converting enzyme 2 (ACE2) receptor with the SARS-CoV-2 spike protein. The ACE2 receptor, which has been found in various organs including type I and II pneumocytes, endothelial cells, oral and nasal mucosa, and also the intestinal tissues, liver, kidney, or brain [ 9 , 10 ], has been identified as the key cellular receptor, facilitating the uptake of the SARS-CoV-2 virus into the host cell [ 11 ].…”

Efficacy and Effectiveness of the Herbal Medicinal Product BNO 1016 in the Management of Acute Rhinosinusitis in the Context of Antibiotic Stewardship

“…The authors found positive results approaching significance for BNO 1016 treatment in the reduction of sick leave >7 days in acute upper and lower respiratory tract infections (OR 0.84 [0.7-1.0], p=0.054) [27]. A recent review comparing the existing evidence of different herbal medicinal products in relation to N-acetylcysteine and mometasone furoate nasal spray highlighted the evidence for BNO 1016 in the treatment of ARS [28].…”