General background. The overuse of antibiotics, including for the treatment of uncomplicated acute rhinosinusitis (ARS), has contributed to the emergence of antibiotic-resistant bacterial strains and has led to the need for alternative therapies. The review provides an assessment of the quality of evidence for the use of phytotherapy in ARS in order to determine its position among other therapies and future directions of research. The MEDLINE database was searched for randomized controlled studies of Sinupret®, Pelargonium sidoides extract (pelargonium), Cyclamen europaeum (cyclamen), cineole and GeloMyrtol®. We also searched for results from studies of a nasal spray with N-acetylcysteine and mometasone furoate (MF) in order to compare the effectiveness of herbal preparations with these traditional agents indicated for ARS. Main content. The strongest evidence was obtained for Sinupret®, followed by Pelargonium sidoides extract. Their use for treatment of ARS is supported by double-blind, placebo-controlled studies demonstrating both clinical efficacy and safety. Comparisons with traditional treatments such as topical glucocorticosteroids were found only for Sinupret® and they showed comparable efficacy, but in a small group of patients. For other herbal drugs, the pooled level of evidence was low. The search identified 2 small, placebo-controlled, randomized studies of cyclamen nasal spray. In two studies, it was impossible to make conclusions about the safety and efficacy of cyclamen nasal spray and reported no efficacy of cyclamen in reducing symptoms. We found only one randomized placebo-controlled study of GeloMyrtol® and cineol. The mention studies have showed a reduction in ARS symptoms with these two drugs, but larger studies are needed to confirm these findings. There are few studies that directly compared herbal drugs. In one randomized study, cineol was compared with Sinupret®, but the results need to be confirmed in further studies. Studies of N-acetylcysteine are limited to small clinical trials, while the use of MF nasal spray has been confirmed with results comparable in evidence to Sinupret® for the respective indications. Conclusions. There are modern studies that demonstrate the efficacy and safety of herbal drugs for ARS treatment. Given that the evidence for Sinupret® is the strongest and comparable to that for the widely available topical corticosteroid, MF, Sinupret could be considered for the treatment of uncomplicated ARS.
Effects of
Pelargonium sidoides
extract vs roxithromycin on chemokine levels in nasal secretions of patients with uncomplicated acute rhinosinusitis