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| Treatment and indication | Main conclusions | Study characteristics |
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| Respiratory tract infections (RTIs) | | |
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| Immunostimulants (IS) (including herbal treatments) for preventing respiratory tract infection in children [36] | IS reduce the incidence of acute RTIs by 40% on average in susceptible children
Further RCTs are required | Thirty-five placebo-controlled trials (N = 4.060).
The use of IS was shown to reduce ARTIs measured as the total numbers of ARTIs (MD -1.24; 95% CI: -1.54 to -0.94) and the difference in ARTI rates (MD -38.84%; 95% CI: -46.37% to -31.31%). |
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| Oral Astragalus (Huang qi) for the prevention of frequent acute respiratory tract infections in children [37] | Insufficient evidence of the effectiveness and safety | No studies met the inclusion criteria |
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| Garlic for prevention of the common cold [38] | There is insufficient clinical trial evidence
Further RCTs are required | Only one trial met the inclusion criteria.
N= 146 participants. Interventions: either a garlic supplement (with 180 mg of allicin content) or a placebo (once daily) for 12 weeks.
Results: 24 occurrences of the common cold in the garlic intervention group compared with 65 in the placebo group (p < 0.001), resulting in fewer days of illness in the garlic group compared with the placebo group (111 versus 366). The number of days to recovery from an occurrence of the common cold was similar in both groups (4.63 versus 5.63). |
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| Echinacea for the common cold [39] | There is possibly a weak benefit from some Echinacea products | Twenty-four double-blind trials with 4.631 participants including a total of 33 comparisons of Echinacea preparations and placebo met the inclusion criteria.
None of the 12 prevention comparisons reporting the number of patients with at least one cold episode found a statistically significant difference. However a post hoc pooling of their results suggests a relative risk reduction of 10% to 20%. Of the six treatment trials reporting data on the duration of colds, only two showed a significant effect of Echinacea over placebo. |
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| Pelargonium sidoides for acute rhinosinusitis, the common cold and acute bronchitis [40] | P. sidoides may be effective in alleviating symptoms of acute rhinosinusitis and the common cold in adults, but doubt exists. It may be effective in relieving symptoms in acute bronchitis in adults and children, and sinusitis in adults
The overall quality of the evidence was considered low for main outcomes in acute bronchitis in children and adults, and very low for acute sinusitis and the common cold | Of 10 eligible studies, eight were included in the analyses; two were of insufficient quality. Three trials (746 patients, low quality of evidence) of efficacy in acute bronchitis in adults showed effectiveness for most outcomes in the liquid preparation but not for tablets. Three other trials (819 children, low quality of evidence) showed similar results for acute bronchitis in children.
One study in patients with sinusitis (n = 103 adults, very low quality of evidence) showed significant treatment effects (complete resolution at day 21; RR 0.43, 95% CI: 0.30-0.62).
One study in the common cold demonstrated efficacy after 10 days, but not five days (very low quality of evidence). |
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| Chinese herbals for sore throat [41] | Some Chinese herbal medicines appeared efficacious
Due to methodological weaknesses no final conclusions could be drawn | 12 studies involving 1.954 participants.
Ten studies were identified as being of methodologically poor quality and two studies as being of medium quality. No meta-analyses.
Six formulations were shown to be superior to the control in improving recovery: Ertong Qingyan Jiere Koufuye was more effective than Fufang Shuanghua Koufuye for acute pharyngitis (odds ratio (OR) 2.52; 95% CI: 1.11-5.74); Yanhouling mixture was more effective than gentamicin atomised inhalation for acute pharyngitis (OR 5.39; 95% CI: 2.69-10.81); Qinganlan Liyan Hanpian was more effective than Fufang Caoshanhu Hanpian for acute pharyngitis (OR 2.25; 95% CI: 1.08-4.67); sore throat capsules were more effective than antibiotics (intravenous cefalexin) for acute pharyngitis or acute tonsillitis (OR 2.36; 95% CI: 1.01-5.51); compound dandelion soup was more effective than sodium penicillin for acute purulent tonsillitis (OR 5.06; 95% CI: 1.70-15.05); and eliminating heat by nourishing yin and relieving sore-throat methods combined with Dikuiluqan Hanpian were more effective than Dikuiluqan Hanpian alone for children with chronic pharyngitis (OR 2.63; 95% CI: 1.02-6.79). Another six formulations were shown to be equally efficacious as the control. |
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| Chinese medicinal herbs for acute bronchitis [42] | There is insufficient quality data | None of 74 studies involving 6.877 participants met the inclusion criteria. |
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| Urinary tract infections (UTIs) | | |
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| Chinese herbal medicine (CHM) for recurrent urinary tract infections [43] | CHM as an independent intervention or in conjunction with antibiotics may be beneficial for treating recurrent UTIs during the acute phase of infection and may reduce the recurrent UTI incidence for at least six months post-treatment
Better quality evidence is needed | Seven RCTs involved a total of 542 women; of these, five recruited post-menopausal women (aged from 56 to 70 years) (422 women).
All studies were assessed to be at high risk of bias.
Analysis of three studies involving 282 women that looked at CHM versus antibiotics suggested that CHM had a higher rate of effectiveness for acute UTI (RR 1.21, 95% CI: 1.11–1.33) and reduced recurrent UTI rates (RR 0.28, 95% CI: 0.09-0.82). Analysis of two studies involving 120 women that compared CHM plus antibiotics versus antibiotics alone found the combined intervention had a higher rate of effectiveness for acute UTI (RR 1.24, 95% CI: 1.04-1.47) and resulted in lower rates of recurrent infection six months after the study (RR 0.53, 95% CI: 0.35-0.80).
One study comparing different CHM treatments found Er Xian Tang was more effective in treating acute infection in post-menopausal women than San Jin Pian (80 women: RR 1.28, 95% CI: 1.03-1.57). Analysis showed that active CHM treatments specifically formulated for recurrent UTI were more effective in reducing infection incidence than generic CHM treatments that were more commonly used for acute UTI (RR 0.40, 95% CI: 0.21-0.77). |
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| Probiotics for preventing urinary tract infections in adults and children [44] | There is insufficient quality data | Nine studies involved 735 people. Four studies compared probiotic with placebo, two compared probiotic with no treatment, two compared probiotics with antibiotics in patients with UTI, and one study compared probiotic with placebo in healthy women. All studies aimed to measure differences in rates of recurrent UTI.
Overall, there was a high risk of bias in the included studies.
No significant reduction in the risk of recurrent symptomatic bacterial UTI was found between patients treated with probiotics and placebo (6 studies, 352 participants: RR 0.82, 95% CI: 0.60-1.12; I2 = 23%).
No significant reduction in the risk of recurrent symptomatic bacterial UTI was found between probiotic and antibiotic treated patients (1 study, 223 participants: RR 1.12, 95% CI: 0.95-1.33). |
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| Other infections | | |
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| Chinese medicinal herbs for preventing infection in nephrotic syndrome [45] | A compound of Chinese medicinal herbs—Tiaojining—may have positive effects on prevention of nosocomial or unspecified infection with no obvious serious adverse events in children with nephrotic syndrome
Better quality evidence is needed | Twelve studies conducted in China, including 762 children with nephrotic syndrome were identified. No studies were identified in adults. All studies compared one kind of prophylactic pharmacotherapy (intravenous immunoglobulin (IVIG), thymosin, oral transfer factor, mannan peptide tablet, Bacillus Calmette-Guerin (BCG) vaccine injection, polyvalent bacterial vaccine (Lantigen B) and two kinds of Chinese medicinal herbs: a compound of Chinese medicinal herbs (Tiaojining) and Huang qi (astragalus) granules) plus baseline treatment with baseline treatment alone. No RCTs were identified comparing antibiotics, non-pharmacological prophylaxis, or pneumococcal vaccination.
Four studies showed a significantly beneficial effect of IVIG on preventing nosocomial or unspecified infection in children with nephrotic syndrome (RR 0.47, 95% CI: 0.31-0.73). Thymosin (RR 0.50, 95% CI: 0.26-0.97), oral transfer factor (RR 0.51, 95% CI: 0.35-0.73), BCG vaccine injection (RR 0.68, 95% CI: 0.48-0.95), Huang qi granules (RR 0.62, 95% CI: 0.47-0.83) and Tiaojining (RR 0.59, 95% CI: 0.43-0.81) were also effective in reducing the risk of infection in children with nephrotic syndrome. However mannan peptide tablet (RR 0.46, 95% CI: 0.21-1.01) and polyvalent bacterial vaccine (RR 0.24, 95% CI: 0.06-1.00) were not superior to baseline treatment in reducing the risk of infection for nephrotic children. |
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| Honey for infected post-operative wounds [46] | Honey appeared to heal infected post-operative wounds more quickly than antiseptics and gauze | One trial (N = 50) on infected post-operative wounds.
Honey healed infected post-operative wounds more quickly than antiseptic washes followed by gauze and was associated with fewer adverse events (moderate quality evidence, RR of healing: 1.69, 95% CI: 1.10-2.61). |
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| Chinese herbal medicines for skin and soft-tissue infections [47] | No RCTs that met the inclusion criteria > No conclusion | |
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