Rhinosinusitis is an inflammatory process involving one or more of the paranasal sinuses that typically follows a viral upper respiratory tract infection (RTI). The term ‘acute rhinosinusitis’ is used instead of ‘acute sinusitis’ because it is the currently internationally accepted terminology.

Health authority says: Change prescribing behaviour
Recently, the UK National Institute for Health and Clinical Excellence (NICE) has issued a clinical guideline for UK doctors advising that antibiotics should no longer be used routinely in upper respiratory conditions including but not limited to acute rhinosinusitis. “Most people presenting in primary care with an acute uncomplicated RTI will still receive an antibiotic prescription.” Paul Little, Professor of Primary Care Research, GP and Chair, Guideline Development Group states in the NICE Guidelines. This prescribing behaviour should be changed because “antibiotics are not needed immediately because they are likely to make little difference to symptoms and may have side effects, for example, diarrhoea, vomiting and rash” and because “antibiotic resistance rates are strongly related to antibiotic use in primary care.”

Researchers from the independent and non-profit Cochrane Collaboration state in a recent review of acute respiratory tract infections “In the light of inappropriate antibiotic use and increasing drug resistance rates worldwide, the need for an alternative, effective remedy for these medical conditions is crucial.”

Study shows herbal medicine to be effective cure

In the search for an alternative treatment strategy, Bachert et al. conducted a randomized, double-blind study including 103 patients with radiographically and clinically confirmed acute rhinosinusitis of presumably bacterial origin. The researchers carefully selected patients on the basis of symptom duration (> 7 days) to exclude viral rhinitis. Sinus X-rays were used to confirm the probable bacterial nature of the infections. For up to 22 days patients received either 60 drops of Pelargonium sidoides extract EPs^® 7630 or a matching placebo three times daily. When assessing the severity of the disease using the Sinusitis Severity Score (SSS), the mean decrease was 5.5 points in the EPs^® 7630 group compared to 2.5 points in the placebo group, a difference of 3.0 points at day seven. This highly significant and clinically relevant result was confirmed by all secondary parameters indicating a more favourable course of the disease and a faster recovery in the EPs^® 7630 group. The mean duration of inability to work was cut nearly to half from 15.9 days in the placebo group to 8.7 days in the EPs^® 7630 group. The treatment was well tolerated.

The authors concluded that “EPs^® 7630 was well tolerated and superior in efficacy compared to placebo in the treatment of acute rhinosinusitis of presumably bacterial origin“.

The standardized extract of Pelargonium sidoides EPs^® 7630 is contained in Umckaloabo^®, a leading cough and cold medicine in Germany. It is currently available under different brand names in more than 40 countries world-wide.

[1] Bachert C, Schapowal A, Funk P, Kieser M. Treatment of acute rhinosinusitis with the preparation from Pelargonium sidoides EPs 7630: a randomized, double-blind, placebo-controlled trial. Rhinology. 2009 Mar;47(1):51-8.

[2] Timmer A, Günther J, Rücker G, Motschall E, Antes G, Kern WV. Pelargonium sidoides extract for acute respiratory tract infections. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006323. DOI: 10.1002/14651858.CD006323.pub2.

[3] NICE clinical guideline 69: Respiratory tract infections – antibiotic prescribing. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. Issue date: July 2008.

[4] Young J, De Sutter A, Merenstein D et al. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet. 2008. 371: 908-14.