Pelargonium sidoides for acute bronchitis

Integrative Medicine

Pelargonium sidoides, a plant native to coastal South Africa, is commonly known as South African geranium.1 In Western medicine, the plant has been used to treat the common cold and acute bronchitis. Its mechanism of action may include a cytoprotective effect against viral attack, an antimicrobial effect through the release of defensins from neutrophilic granulocytes, and an immune-boosting effect through the release of tumor necrosis factor, nitrous oxide, and an increase in natural killer cell activity.2,3 

Efficacy and safety

Researchers have assessed the efficacy of P. sidoides for acute bronchitis. One randomized double-blind study evaluated its safety and efficacy in 468 patients with acute bronchitis treated by 36 primary care physicians.4 One of the aims was to address concerns about unnecessary or inappropriate antibiotic use.Success was based on change in bronchitis severity score over the 7-day treatment period. The results demonstrated less time lost from work, a shorter duration of illness, and a more rapid onset of clinical effect for the treatment group compared with the placebo group.

A Cochrane systematic review assessed the safety and efficacy of P. sidoides in the treatment of acute respiratory infections (ARIs) in adults and children.5 The review included randomized controlled trials that examined its efficacy in ARIs compared with placebo, no treatment, or any other treatment. The primary outcome was complete resolution of symptoms. The results were mixed, though some of this heterogeneity may be due to the ineffectiveness of P. sidoides in tablet dosage form and the potential ineffectiveness of the product in children. Adverse events were more common in groups treated with P. sidoides, but none of them were considered serious. 

Based on this data, P. sidoides may be effective for the treatment of acute bronchitis, but its value as a therapy for acute rhinitis and the common cold has not been established.5

As a homeopathic remedy, P. sidoides extract is available as Nature’s Way Umcka ColdCare Original Drops with a dosage of 1.5 mL orally three times daily. Although usually well tolerated, P. sidoides has potential adverse effects that include allergic reaction, increased risk of bleeding, and liver toxicity. The allergic reaction may present as rash and itching with or without edema, bronchospasm, and dyspnea. 

What to tell patients

Acute bronchitis is generally due to a virus and will resolve within 1 to 2 weeks, though coughing may persist. Antibiotics are not indicated and, in general, should be avoided to limit the spread of antibiotic resistance. If patients smoke, they should attempt to limit their smoking and exposure to other respiratory irritants. Encourage patients to increase their fluid intake and use a humidifier. The available evidence has suggested some efficacy of P. sidoides in the treatment of acute bronchitis. Caution should be exercised when the product is used in patients taking anticoagulant therapy, as well as those with hepatic dysfunction; however, evidence is limited. Advise patients to discontinue use immediately if signs of an allergic reaction appear.

References

Bladt S, Wagner H. From the Zulu medicine to the European phytomedicine Umckaloabo. Phytomedicine. 2007;14(suppl 1):2–4.

Koch E, Wohn C. Pelargonium sidoides root extract EPs 7630 stimulates release antimicrobial peptides from neutrophile granulocytes in human whole blood. Planta Medica. 2007;73:846.

Kolodziej H, Kiderlen AF. In vitro evaluation of antibacterial and immunomodulatory activities of Pelargonium reniforme, Pelargonium sidoides and the related herbal drug preparation EPs 7630. Phytomedicine. 2007;14(suppl 1):18–26.

Matthys H, Eisebitt R, Seith B, Heger M. Efficacy and safety of an extract of Pelargonium sidoides (EPs 7630) in adults with acute bronchitis: a randomised, double-blind, placebo-controlled trial. Phytomedicine. 2003;10(suppl 4):7–17.

Timmer A, Günther J, Rücker G, et al. Pelargonium sidoides extract for acute respiratory tract infections. Cochrane Database Syst Rev. 2008:CD006323.