Pelargonium sidoides for the treatment of acute bronchitis: a systematic review and meta-analysis

Due to the limited success of antibiotics, cost, adverse effects and antibiotic resistance more attention is now focused on alternative medications for acute bronchitis, hence the search for effective herbal options. The aim of the study was to systematically assess the efficacy of Pelargonium sidoides preparations for the treatment of acute bronchitis. Systematic literature searches were conducted in Medline, Amed, Embase, Cinahl and Cochrane controlled trials register from inception up to April 2007 without language restrictions. Reference lists of retrieved articles were searched, and manufacturers contacted for published and unpublished materials. Randomized clinical trials (RCTs) testing P. sidoides extract against placebo or standard treatment in patients with acute bronchitis and assessing clinically relevant outcomes were included. Two reviewers extracted and validated relevant data independently. Methodological quality was evaluated with the Jadad score [1]. Six RCTs met the inclusion criteria, of which 4 (n=1012) reported enough detail for inclusion in the meta-analysis. One study compared EPs®7630 against conventional non-antibiotic treatment (acetylcysteine); the other five studies tested EPs®7630 against placebo. All studies reported findings suggesting the effectiveness of P. sidoides in treating acute bronchitis. Meta-analysis of the four placebo- controlled RCTs suggested that EPs®7630 significantly reduced bronchitis symptom scores in patients with acute bronchitis by day 7 (weighted mean difference 2.80, 95% CI 2.44 to 3.15). No serious adverse events were reported. The overall quality of trials was good and reporting of outcomes consistent. There is encouraging evidence that P. sidoides may reduce the symptoms of acute bronchitis.

Acknowledgements TBJ's research fellowship is funded by Dr Willmar Schwabe Pharmaceuticals. Karlsruhe, Germany.

References: [1] Jadad, A.R et al. (1996), Assessing the Quality of Reports of Randomized Clinical Trials: Is Blinding Necessary? Control. Clin. Trials 17: 1–12.