Andrographis paniculata in the Treatment of Upper Respiratory Tract Infections: A Systematic Review of Safety and Efficacy

Abstract

Acute respiratory infections represent a significant cause of over-prescription of antibiotics and are one of the major reasons for absence from work. The leaves of Andrographis paniculata (Burm. f.) Wall ex Nees (Acanthaceae) are used as a medicinal herb in the treatment of infectious diseases. Systematic literature searches were conducted in six computerised databases and the reference lists of all papers located were checked for further relevant publications. Information was also requested from manufacturers, the spontaneous reporting schemes of the World Health Organisation and national drug safety bodies. No language restrictions were imposed. Seven double-blind, controlled trials (n = 896) met the inclusion criteria for evaluation of efficacy. All trials scored at least three, out of a maximum of five, for methodological quality on the Jadad scale. Collectively, the data suggest that A. paniculata is superior to placebo in alleviating the subjective symptoms of uncomplicated upper respiratory tract infection. There is also preliminary evidence of a preventative effect. Adverse events reported following administration of A. paniculata were generally mild and infrequent. There were few spontaneous reports of adverse events. A. paniculata may be a safe and efficacious treatment for the relief of symptoms of uncomplicated upper respiratory tract infection; more research is warranted.

Key words

Medicinal plants - herbal medicine - upper respiratory infections - systematic review - Andrographis paniculata - Acanthaceae

References

• 1 Morbidity statistics from general practise; 4th National Survey 1991 - 1 992. Office of Population Censuses and Surveys 1995 London, HMSO;
• 2 Fahey T, Stocks N, Thomas T. Systematic review of the treatment of upper respiratory tract infection.  Arch Dis Child. 1998;  79 225-30
• 3 Neu H C. The crisis in antibiotic resistance.  Science. 1992;  257 1064-73
• 4 Kessler R C, Davis R B, Foster D F, Van Rompay M, Walters E E, Wilkey S A. et al . Long term trends in the use of complementary and alternative medical therapies in the United States.  Ann Intern Med. 2001;  135 262-8
• 5 Shen Y C, Chen C F, Chiou W F. Andrographolide prevents oxygen radical production by human neutrophils: possible mechanism (s) involved in its anti-inflammatory effect.  Br J Pharmacol. 2002;  135 399-406
• 6 Amroyan E, Gabrielian E, Panossian A, Wikman G, Wagner H. Inhibitory effect of andrographolide from Andrographis paniculata on PAF-induced platelet aggregation.  Phytomedicine. 1999;  6 27-31
• 7 Madav S, Tripathi H C, Tandan S K, Mishra S. Analgesic, antipyretic and antiulcerogenic effect of andrographolide.  Indian J Pharm Sci. 1995;  57 121-5
• 8 Vedavathy S, Rao K N. Antipyretic activity of six indigenous medicinal plants of Tirumala Hills, Andhra Pradesh, India.  J Ethnopharmacol. 1991;  33 193-6
• 9 Chang R S, Ding L, Chen G Q, Pan Q C, Zhao Z L, Snith K M. Dehydrographolide succinic acid monoester as an inhibitor against the human immunodeficiency virus.  Proc Soc Exp Biol Med. 1991;  197 59-66
• 10 Puri A, Saxena R, Saxena R P, Saxena K C, Srivastava V, Tandon J S. Immunostimulant agents from Andrographis paniculata .  J Nat Prod. 1993;  56 995-9
• 11 Reynolds J EJ, editor. Martindale: The Extra Pharmacopoeia. London; The Royal Pharmaceutical Scoiety 1996
• 12 Rote Liste® Service GmbH, Frankfurt. Rote Liste 1999. Aulendorf, Germany; Editio Cantor Verlag 1999
• 13 Jadad A R, Moore A, Carroll D, Jenkinson C, Reynolds D J, Gavaghan D J. et al . Assessing the quality of reports of randomised clinical trials: Is blinding necessary?.  Controlled Clinical Trials. 1996;  17 1-12
• 14 Caceres D D, Hancke J L, Burgos R A, Sandberg F, Wikman G K. Use of visual analogue scale measurements (VAS) to assess the effectiveness of standardised Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomised double blind placebo study.  Phytomedicine. 1999;  6 217-23
• 15 Gabrielian E, Shukarian A K, Goukasova G, Chandanian G L, Panossian A G, Wikman G. et al . A double blind, placebo controlled study of Andrographis paniculata in fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis.  Phytomedicine. 2002;  9 589-97
• 16 Hancke J L, Burgos R A, Caceres D D, Wikman G. A double blind study with a new monodrug Kan Jang: decrease of symptoms and improvement in the recovery from common colds.  Phytotherapy Research. 1995;  9 559-62
• 17 Melchior J, Palm S, Wikman G. Controlled clinical study of standardised Andrographis paniculata extract in common cold - a pilot trial.  Phytomedicine. 1996;  3 315-8
• 18 Melchior J, Spasov A A, Ostrovskij O V, Bulanov A E, Wikman G. Double blind, placebo controlled pilot and Phase III study of activity of standardised Andrographis paniculata Herba Nees extract fixed combination (Kan jang) in the treatment of uncomplicated upper respiratory tact infection.  Phytomedicine. 2000;  7 341-50
• 19 Thamlikitkul V, Dechatiwongse T, Theerapong S, Chantrakul C, Boonroj P, Punkrut W. et al . Efficacy of Andrographis paniculata, Nees for pharyngotonsillitis in adults.  J Med Assoc Thai. 1991;  74 437-42
• 20 Calabrese C, Berman S H, Babish J G, Ma X, Shinto L, Dorr M. et al . A phase I trial of andrographolide in HIV positive patients and normal volunteers.  Phytotherapy Research. 2000;  14 333-8
• 21 Panossian A, Hovhannisyan A, Mamikinyan G, Abrahamian H, Hambardzumyan E, Gabrielian E. et al . Pharmacokinetic and oral bioavailability of andrographolide from Andrographis paniculata fixed combination Kan Jang in rats and human.  Phytomedicine. 2000;  7 351-64
• 22 Leelarasamee A, Trakulsomboon S, Sittisomwong N. Undetectable anti-bacterial activity of Andrographis paniculata (Burma) Wall. ex Ness.  J Med Assoc Thai. 1990;  73 299-304
• 23 Zhang Y -Z, Tang J -Z, Zhang Y -J. et al . Study of Andrographis paniculata extracts on antiplatelet aggregation and release reaction and its mechanism.  Chin J Int Med. 1994;  14 5
• 24 Muangman V, Viseshsindh V, Ratana-Olarn K, Buadilok S. The usage of Andrographis paniculata following extracorporeal shock wave lithotripsy (ESWL).  J Med Assoc Thai. 1995;  78 310-2
• 25 Vedavathy S, Rao D N. Herbal folk medicine of Tirumala and Tirupati region of Chittoor district, Andhra Pradesh.  Fitoterapia. 1995;  66 167-71
• 26 Kuwashima K, Kaneko H, Nakanishi K. Studies of clinical effects of ginseng: 1st report; a double blind study of unsettled complaint improving effect of ginseng. Proceedings of the 3rd International Ginseng Symposium 1980: 187-91
• 27 Akbarsha M A, Manivannan B, Hamid K S, Vijayan B. Antifertility effect of Andrographis paniculata (Nees) in male albino rat.  Indian J Exp Biol. 1990;  28 421-6
• 28 Akbarsha M A, Murugaian P. Aspects of the male reproductive toxicity/male antifertility property of andrographolide in albino rats: effects on the testis and the cauda epididymidal spermatozoa.  Phytotherapy Research. 2000;  14 432-5
• 29 Panossian A, Kochikian A, Gabrielian E, Muradian R, Stepanian H, Arsenian F. et al . Effect of Andrographis paniculata extract on progesterone in blood plasma of pregnant rats.  Phytomedicine. 1999;  6 157-62
• 30 Burgos R A, Caballero E E, Sanchez N S, Schroeder R A, Wikman G K, Hancke J L. Testicular toxicity assessment of Andrographis paniculata dried extract in rats.  J Ethnopharmacol. 1997;  58 219-24
• 31 Easterbrook P J, Berlin J A, Gopalan R, Matthews D R. Publication bias in clinical research.  Lancet. 1991;  337 867-72
• 32 Barnes J, Mills S Y, Abbot N C, Willoughby M, Ernst E. Different standards for reporting ADRs to herbal remedies and conventional OTC medicines: face to face interviews with 515 users of herbal medicines.  Br J Clin Pharmacol. 1998;  45 96-500
• 33 Smith C C, Bennett P M, Pearce H M. et al . Adverse drug reactions to a hospital general medical unit meriting notification to the Committee on Safety of Medicines.  Br J Clin Pharmacol. 1996;  42 423-9
• 34 Habtemariam S. Andrographolide inhibits the tumour necrosis factor-α-induced upregulation of ICAM-1 expression and endothelial-monocyte adhesion.  Phytotherapy Research. 1998;  12 37-40
• 35 Caceres D D, Hancke J L, Burgos R A, Wikman G K. Prevention of common colds with Andrographis paniculata dried extract. A pilot double blind trial.  Phytomedicine. 1997;  4 101-4