Upper-Respiratory-Tract Infection in Children

Abstract and Introduction

Abstract

Purpose: Evidence on the efficacy and safety of complementary and alternative medicine (CAM) for the prevention and treatment of upper-respiratory-tract infection (URTI) in children is reviewed.
Summary: A search of the literature to June 2005 identified six clinical trials examining the use of herbal medicines and nine trials of other CAM therapies. All articles were critically evaluated for adherence to standards of efficacy and safety research. Echinacea did not reduce the duration and severity of URTI. Andrographis paniculata or echinacea decreased nasal secretions (p < 0.01) but not URTI symptoms. A combination of echinacea, propolis, and ascorbic acid decreased the number of URTI episodes, the duration of symptoms, and the number of days of illness (p < 0.001). Echinacea was associated with a higher frequency of rash compared with placebo (p = 0.008). Neither ascorbic acid nor homeopathy was effective. The efficacy of zinc was not clear, and zinc may be associated with adverse effects in children. Osteopathic manipulation decreased episodes of acute otitis media (p = 0.04) and the need for tympanostomy tube insertion (p = 0.03) in children with recurrent acute otitis media. Stress-management therapy reduced the duration of URTI compared with relaxation therapy with guided imagery or standard care (p < 0.05).
Conclusion: Current data are generally inadequate to support CAM for the prevention or treatment of URTI in children.

Introduction

Upper-respiratory-tract infection (URTI) occurs commonly in childhood. On average, a healthy three-year-old child suffers from 6−10 colds per year.^[1] URTIs are usually mild, viral, and self-limiting; however, the symptoms can cause fever and make children irritable, lethargic, and uncomfortable. The treatment strategy is to minimize symptoms and discomfort. Although widely used, nonprescription cough and cold preparations may not be effective for symptom control or shortening the illness. They may cause a wide variety of adverse effects, including paradoxical reactions and toxicity with unintentional overdosage, particularly in children less than three years old.^[2,3,4,5,6]

Complementary and alternative medicine (CAM) has been defined as "interventions neither taught widely in medical schools nor generally available in U.S. hospitals."^[7] They are also referred to as nonallopathic, unconventional, holistic, or natural therapy.^[8] The Cochrane Collaboration defines CAM as "a broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health systems in a particular society or culture in a given historical period."^[9] Generally, CAM products are used either in addition to or as a replacement of traditional Western medical or surgical treatment. CAM products include herbs, acupuncture, chiropractic spinal manipulation, homeopathy, relaxation techniques, diet, hypnosis, and spiritual healing.^[7,8]

In the United States, herbal products are not regulated by the Food and Drug Administration (FDA) as medicines and are considered dietary supplements. Thus, they do not necessarily undergo quality-control analysis to document the amount and purity of active ingredients and to support their claims of efficacy and safety. Herbal preparations should meet the standards of the Dietary Supplement and Health Education Act (DSHEA). However, the DSHEA does not set a standard for evidence of efficacy or safety, nor does it require submission of the evidence to FDA.^[10,11] The safety of these products may be of concern given the lack of clinical trials, particularly in specific chronically ill patient populations. Pharmacokinetic data on absorption, distribution, metabolism and elimination pathways, and potential drug interactions are often lacking.^[12,13,14]

An estimated 1.8% of children in the United States are treated with CAM.^[15] However, the frequency of CAM use has been shown to be higher (by 8−80%) in children with chronic illnesses, in homeless youths, and among children and their families in or from foreign countries.^{[8,15,16,17,18,19]} A survey in a U.S. pediatric emergency department found that the top reason for CAM use was respiratory problems and that the second most common reason was ear, nose, and throat problems.^[17]

A survey of parents in a pediatric emergency department found that 77% of parents who gave herbal medicines to their children were unaware of any potential adverse effects or drug interactions and considered the products to be safe.^[20] Some CAM products, such as herbals, may cause adverse effects due to pharmacokinetic and pharmacodynamic interactions with other drugs.

Several CAM products are being touted for the prevention or treatment of URTI. Given the prevalence of URTI in children and evidence suggesting that traditional nonprescription or antibiotic treatment of URTI may not be effective or safe in children, CAM may be considered a reasonable alternative by many caregivers.

The purpose of this article is to review the evidence on the efficacy and safety of CAM for the prevention and treatment of URTI in children.

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