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|Date: February 15, 2005||HC# 110344-274|
Re: Botanical Strategies for Treating Upper Respiratory Infections in Children
Romm A. Upper respiratory infection (URI) in children: the emerging need for botanical strategies. J Am Herbalists Guild. 2004;Spring/Summer:26-36.
Romm A. Efficacy and safety of echinacea in treating upper respiratory tract infections (URI) in children: a continuing source of controversy. J Am Herbalists Guild. 2004;Spring/Summer:43-46.
Upper respiratory infection (URI) is an acute condition that involves inflammation of the respiratory mucosa from the nose to the lower bronchi. Typical URIs include the common cold, pharyngitis, sinusitis, cough, and ear infections, all of which are usually of viral origin and thus are nonresponsive to antibiotics. However, until recently, many physicians have routinely prescribed antibiotics for URIs, which has led to an excessive use of antibiotics and subsequently to pneumococci that are antibiotic resistant. This The Centers for Disease Control and Prevention, the American Association for Pediatrics, the American Academy of Family Physicians, the World Health Organization, and the American Society for Microbiology are all seeking to limit the overprescription of antibiotics for common childhood URIs.
Because of the emergence of antibiotic resistance, clinicians are searching for alternative botanical therapies for the treatment of common childhood URIs. Once it has been established that a child has a typical URI and not a serious infection, a two-part plan of treatment should be implemented: an herbal plan and a progress assessment plan. The herbal plan involves a determination by the parent or caregiver of the type of herb that is affordable and the form of administration acceptable to the child. If a child does not completely recover from an infection, the chance of recurrence is high. Once the herbal plan has been implemented, a protocol should be established to evaluate the effectiveness of treatment. Objective measures of the child's condition should be monitored and professional care sought if improvements do not occur within a reasonable amount of time.
Few clinical trials of the efficacy of botanical treatments for URIs have been conducted; however, the number of herbs used to treat URIs is vast. This article contains individual charts listing several botanical choices for the treatment of the common cold, fever, sore throat, cough, sinus infection, and otitis media (ear infection). Echinacea (Echinacea spp.) is probably the most commonly used herb to treat these conditions, especially the common cold, although trials of its efficacy have yielded conflicting results. A recent randomized, double-blind, placebo-controlled trial of the efficacy of Echinacea purpurea in reducing the severity and duration of URIs in children (aged 2–11 years) was conducted.1 The children received either echinacea or placebo for 3 to 4 URIs over a 4-month period. Although echinacea was generally well-tolerated; some children developed a rash.
The authors concluded that echinacea was not effective in treating URI symptoms. However, critics of this study note that the authors studied a syrup-based preparation made from aerial plant parts. The author contends that herbalists primarily use fresh root preparations to treat URIs. Also, the children in this study concomitantly used other medications and/or dietary supplements during the study, including antibiotics, which likely affected the results. In addition, "a finding that was not part of the trial's primary outcomes, children in the echinacea group experienced fewer second and third upper respiratory tract infections (URIs) than children in the placebo group in the 4-month trial. In total, parents reported 707 cases of URIs in the study, reported in 407 children. There were 370 cases of URI in children treated with placebo but only 337 URIs in those treated with echinacea. Of the children with at least 1 URI, 64.4% of those receiving placebo had more than 1 URI compared with 52.3% of children receiving echinacea (P = 0.015)."2
Other botanical treatments of URIs include garlic (Allium sativum), which is used as a general antimicrobial and to support the immune system. Licorice (Glycyrrhiza glabra) is useful in soothing sore throats and as a cough suppressant. Thyme (Thymus vulgaris) is used to quell the inflammation of mucous membranes in the nose, throat, and ear, usually in combination with other herbs such as elder flower (Sambucus nigra). Diet is also an important component of the treatment strategy for URIs. A healthy diet of whole grains, vegetables, fruit, and protein will help restore strength and prevent a relapse. The frequent consumption of fluids is essential to prevent dehydration, especially when fever is present; warm beverages and broths are ideal. Because disease transmission is most likely to occur via hand-to-hand contact, prevention should also be emphasized. One of the most effective strategies for preventing URIs is frequent hand washing.
In summary, because most children experience as many as 6 to 8 URIs annually, which results in daycare and school absenteeism as well as work absenteeism for parents and caregivers, the need for safe and effective botanical strategies for treating these infections is great.
—Brenda Milot, ELS
1Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA. 2003;290(21):2824–2830.
2American Botanical Council. American Botanical Council Emphasizes Potential Benefits of Echinacea Syrup for Children’s Colds in New Clinical Trial (Press Release). 2003; December 1.