The study, funded by the NIHR School for Primary Care Research (SPCR) and published in the PLOS ONE, is the first systematic review on A. Paniculata for ARTIs that included searching both English and Chinese databases, without any language restriction.
... In the future we hope this will lead to reduced reliance on antibiotic for these largely self-limiting illnesses"
- Prof Michael Moore
Respiratory tract infections (RTIs) are one of the most common reasons for GP consultations in the UK and 75% of all antibiotic prescribing arises in this setting. Research has suggested RTIs are predominantly caused by viruses, and that antibiotics are of very limited benefit in the majority of uncomplicated infections.
Currently in the UK, although herbs are readily available to the public and becoming increasingly popular, rigorous research into effectiveness, safety, and quality of herbal medicine is needed. One of the biggest motivations supporting this area of research, is the evolving global threat to public health of anti-microbial resistance (AMR). The reduction of antibiotic prescribing is now a major priority for the government and the NIHR.
Professor Michael Moore from Primary Care and Population Science, University of Southampton said: “It is clear that most of the time antibiotics have very limited impact on the symptoms from respiratory infections so the search is on to find alternative approaches to provide symptom relief. Andrographis appears both safe and helpful and probably has a role to play. In the future we hope this will lead to reduced reliance on antibiotic for these largely self-limiting illnesses”.
A. Paniculata has traditionally been used as an antipyretic for relieving and reducing the severity and duration of symptoms of common colds and alleviating fever, cough and sore throats. The key component, known as the andrographolides, have shown anti-inflammatory, antiviral, anti-allergic, and immune-stimulatory activities.
The systematic review assessed data for 7175 patients across 33 trials in six countries, which evaluated the effects of relieving ARTI symptoms, particularly cough and sore throat as the target symptoms (as measured by changes in symptoms scored on visual analogue scales or a Likert-type scale, global assessment of symptom improvement by the patient and/or clinician), and adverse events (anaphylactic, allergic reactions, hypersensitivity reactions, or complications of A. Paniculata).
It showed that A. Paniculata improved severity of cough and sore throat when compared with placebo. A. Paniculata (alone or plus usual care) has a statistically significant effect in improving overall symptoms of ARTIs when compared to placebo, usual care, and other herbal therapies. Evidence also suggested that A. Paniculata (alone or plus usual care) shortened the duration of cough, sore throat and sick leave/time to resolution when compared versus usual care. No major AEs were reported and minor AEs were mainly gastrointestinal.
The review is limited in that the methodological quality of included trials was overall poor; and most included trials evaluated A. Paniculata provided commercially but seldom reported manufacturing or quality control details.
Well-designed trials evaluating effectiveness, efficacy and safety of A. Paniculata as a monotherapy, or as an herbal mixture, as well as exploring its potential to reduce antibiotic prescribing in primary care, are warranted. “We are planning to undertake a formal trial in the UK to confirm these findings and to measure the impact on antibiotic prescribing”， Professor Michael Moore added. Findings of this review will also facilitate the development of the trial at the University of Southampton.
Publication: Andrographis paniculata (Chuān Xīn Lián) for symptomatic relief of acute respiratory tract infections in adults and children: A systematic review and meta-analysis. Xiao-Yang Hu, Ruo-Han Wu, Martin Logue, Clara Blondel, Lily Yuen Wan Lai, Beth Stuart, Andrew Flower, Yu-Tong Fei, Michael Moore, Jonathan Shepherd, Jian-Ping Liu, George Lewith.