Results of a randomised controlled study on the efficacy of a combination of saline irrigation and Sinupret syrup phytopreparation in the treatment of acute viral rhinosinusitis in children aged 6 to 11 years

Phytotherapy for acute respiratory tract infections in children: a systematically conducted, comprehensive review

Background

The need to reduce the inappropriate use of antibiotics for the treatment of pediatric acute respiratory tract infections (ARTIs) calls for therapeutic alternatives. The use of herbal medicines (phytopharmaceuticals) to treat ARTIs has increased worldwide. However, the evidence of phytopharmaceutical treatment, especially for children with ARTIs, has not yet been comprehensively presented.

Objective

To identify evidence on the efficacy and tolerability of phytopharmaceuticals in children suffering from ARTIs.

Methods

We searched the literature using two databases (PubMed and Cochrane Library) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify records of clinical studies investigating the administration of phytopharmaceuticals in children with upper ARTIs (AURTIs) and/or lower ARTIs (ALRTIs).

Results

A total of 45 reports met the eligibility criteria and were included in our review. Of these, only nine reported double-blind, placebo-controlled trials investigating the efficacy and tolerability of phytopharmaceuticals in pediatric ARTIs. Overall, the included reports covered phytopharmaceuticals with the following single active ingredients: various purple coneflower (Echinacea purpurea L.) preparations, ivy (Hedera helix L.) leaf dry extract, African geranium (Pelargonium sidoides L.) root extract (EPs 7630), and pineapple fruit and stem extract preparation. In addition, various reports were included for fixed combination phytopharmaceutical products: eucalyptus oil combinations, five-herb fixed combination extract [BNO 1012 syrup], seven-herb fixed preparation [BNO 1030 solution], thyme herb and ivy leaf extracts, purple coneflower and sage leaf spray, thyme and primrose root extracts, and a preparation containing upper plant parts and roots of purple coneflower, propolis and vitamin C. The most robust efficacy and tolerability evidence available was found for EPs 7630: six double-blind, placebo-controlled trials, eight meta-analyses, four prospective open-label studies, and two observational studies, demonstrating efficacy and good tolerability.

Conclusion

Among the phytopharmaceuticals identified by our systematically conducted, comprehensive literature review, EPs 7630 is supported by sufficient evidence to be regarded as an appropriate treatment to reduce the severity and duration of AURTIs and ALRTIs in children. Regarding other phytopharmaceuticals reported in the literature for the treatment of pediatric ARTIs, further research is needed to close existing evidence gaps.

Multicenter, randomized, open-label, comparative study of the effectiveness of nasal spray Aqua Maris Extra Strong as a symptomatic therapy in the technology of delayed antibiotic prescription in the treatment of acute rhinosinusitis in children aged 6-11 years

Antibacterial therapy in acute rhinosinusitis (ARS) is prescribed 4-9 times more often than recommended, while no >5 % of patients require such treatment. The main motive for the irrational antibiotic prescription is the presence of mucopurulent discharge and nasal congestion in combination with hyperthermia. The study objective was to determine the efficacy of hypertonic seawater solution in the technology of delayed antibiotic prescription in patients with ARS.

METHODS

In a multicenter, randomized, open-label, comparative study, 100 children were randomized. 100 children with ARS aged 6-11 years, who received Aqua Maris Extra Strong irrigation therapy in addition to standard therapy or received standard therapy, completed the study. EVALUATION CRITERIA: decreased intensity of nasal congestion, rhinorrhea, postnasal drip, headache and facial pain, assessed by the physician using a 4-point scale at each visit compared to Visit 1, dynamics of self-scored symptoms using a 10-point visual analogue scale, frequency of antipyretic and antibiotic prescription.

RESULTS

The use of hypertonic seawater solution in patients with ARS provides a clinically significant reduction in the severity of core or key symptoms: rhinorrhea, nasal congestion, postnasal drip and headache, assessed by the physician at V2 (p < 0.05). There are significant differences in the dynamics of these symptoms according to the patient's self-assessment from treatment Day 2 (p < 0.05). The use of irrigation therapy with Aqua Maris Extra Strong in the technology of delayed antibiotic prescription in patients with ARS allows to reduce the prescription of antibacterial drugs. No on-treatment side effects were observed in any patient.

CONCLUSION

Hypertonic seawater solution Aqua Maris Extra Strong is a safe and effective medicinal product for the symptomatic treatment of acute rhinosinusitis in children aged 6-11 years. It provides a significant therapeutic effect when prescribed in addition to standard therapy and helps to reduce the need for antibiotics.

Exercise Training and Verbena officinalis L. Affect Pre-Clinical and Histological Parameters

Verbena officinalis L. or vervain is an herbal medicine and dietary supplement used worldwide. It is used for antidepressant and anticonvulsant purposes, as well as to treat inflammatory disorders, skin burns, abrasions, and gastric diseases, among others. Here, we investigated the biochemical, antioxidant, and histopathological effects of vervain against chronic physical stress. Male Wistar rats were submitted to chronic physical training and oral administration of 200 mg/kg of extract for 7 weeks. Control animals were not treated with either stress or vervain. Body weight was monitored during the study. Liver, kidney, spleen, testis, epididymis, heart, skeletal muscle, and brain samples were collected. Blood cholesterol, lactate dehydrogenase (LDH), bilirubin, and creatinine kinase (CREA), among others, were studied. Glutathione peroxidase (GPox) and superoxide dismutase (SOD) antioxidant activity was analyzed in the blood, liver, and kidney. Testosterone measurements were also performed on whole testis extracts. We found significant weight ratios differences in the epididymis, brain, and heart. Animals submitted to training showed hemorrhagic livers. Kidney histology was affected by both stress and vervain. Cell disruption and vacuolization were observed in the testes and epididymis of animals submitted to stress. Hematological and biochemical markers as CREA, LDH, TP, CKI, URCA, γGT, and glucose revealed statistically significantly differences. Additionally, the activity of glutathione peroxide (GPox) and superoxide dismutase (SOD) in the blood was also impacted. Both stress and vervain have significant in vivo effects. Infusions of vervain include phenylpropanoids, iridoids, verbenalin, hastatoside, and flavonoids, amongst others, which interact synergistically to produce the preclinical effects reported here.

An open-label, multicentre, randomized comparative study of efficacy, safety and tolerability of the 5 plant - extract BNO 1012 in the Delayed Antibiotic Prescription Method in children, aged 6 to 11 years with acute viral and post-viral rhinosinusitis

Acute rhinosinusitis (ARS) can be characterized as bacterial (ABRS) and require antibiotic therapy only in 0.5-5% of cases. In most cases, the disease is in a viral and post-viral form, which requires pathogenetic and symptomatic treatment. The study objective was to determine the efficacy of BNO 1012 extract in the technology of delayed antibiotic prescribing in children with acute rhinosinusitis.

METHODS

292 children aged 6 to 11 years with ARS were randomized in the multicenter, comparative study. They received an extract of five medicinal plants in addition to standard symptomatic therapy or standard therapy only. EVALUATION CRITERIA: reduction of the sinusitis severity according to a 4-point medical assessment scale (nasal congestion, severity of anterior and posterior rhinorrhea) at each visit, dynamics of self-scoring of rhinorrhea and headache (according to a 10-point visual analogue scale), "therapeutic benefit" in days, frequency of antibiotic prescriptions due to the use of an extract of five plants.

RESULTS

The use of the 5-plant extract BNO 1012 in addition to the standard symptomatic treatment of acute rhinosinusitis provides a clinically significant, adequate reduction in the severity of rhinorrhea, nasal congestion and post-nasal drip, assessed by a physician at V2 (p < 0.005). Significant differences are noted in the patient's self-scoring of rhinorrhea on the second or third day in viral RS, and from the fourth to the eighth day in post-viral RS. Symptoms of similar intensity in control group were observed at V3. Thus, in the first week of treatment, the treatment group compared to the control one showed a "therapeutic benefit" of three days. The use of BNO 1012 in patients with acute rhinosinusitis can 1.81-fold reduce the prescription of antibacterial drugs.

CONCLUSION

The combination of five medicinal plants is effective for the treatment of acute rhinosinusitis in children aged 6 to 11 years. Its use provides a significant "therapeutic benefit" when administered in addition to standard symptomatic therapy, reducing the need for antibiotic use.