BY Samuel Mathis, MD, Assistant Professor, UTMB
With the recent increase in COVID cases over the past month, this year’s flu season is gearing up to be worse than last year potentially. Many times, patients look for alternative therapies that can help prevent or reduce the duration of upper respiratory infections (URI). As a Family Medicine physician, I regularly get patient visits asking for antibiotics after only 1-2 days of cough, congestion, or rhinorrhea. I regularly need something to recommend that shows evidence of helping URI symptoms without increasing their risk of antibiotic resistance down the road. This is where echinacea comes into play. This supplement has been shown to help prevent and can be used as a treatment option for URIs.
Echinacea purpurea is a perennial plant belonging to the Asteraceae family. It originates from North America but can now be found worldwide. The most common medicinal version of Echinacea is the Moench species. Significant research has surfaced regarding echinacea over the past 20 years. There are several bioactive compounds in Echinacea, including glycoproteins, polysaccharides, flavonoids, alkylamides, and phenolic compounds (1). These compounds create the immunomodulatory effects that improve the body’s response to infection. Additionally, these compounds have antioxidant properties that help maintain the body’s oxidative homeostasis during infections (1). Some studies have found echinacea to have antiosteoporosis activity as well due to its antioxidant properties.
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These effects are thought to help the body fight off URIs more effectively. A 2019 systematic review and meta-analysis of 29 trials showed that echinacea had a questionable statistically significant effect on the incidence of URIs (2). Many studies favored echinacea as a preventative, but their confidence interval often crossed 1, meaning no strong statistical significance. The same finding was factual regarding echinacea’s ability to reduce the duration of symptoms. While there was a noticeable decrease, it did not meet statistical significance (2). However, one positive from this study shows that echinacea had fewer side effects or adverse events than placebo.
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Recently there has been more research into echinacea’s effect on COVID-19. A 2022 study found that when used in high doses (4,000mg/day at the start of symptoms), echinacea led to a significant reduction in the overall virus load of Covid 19 (p<0.05) (3). It also reduced the time of viral clearance from 8.0 days to 4.8 days (3). While echinacea reduced fevers, it did not reduce the severity of symptoms. One possible reason for this difference in the studies is the dosing amount used for echinacea. This study used significantly higher amounts of echinacea compared to prior studies.
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So, what are we to do with this information? It seems unreasonable to recommend that patients take over 4,000mg of echinacea per day. Echinacea can be ingested in a variety of ways. The most common formulation of echinacea is a capsule, but liquid drops, teas, and powders can also be used depending on your patient’s preference. Most formulations have 300-500mg of the supplement per dose. I typically recommend patients start taking 2 capsules three times daily at the start of cold symptoms. This equates to 1,800-3,000mg of the supplement per day, a little less than what was utilized in the 2022 study mentioned above. For patients who dislike capsules, I often recommend making an echinacea tea with lemon and honey to help with the sore throat and cough.
Finally, echinacea may not be for everyone. This supplement can occasionally cause upset stomach, change in bowel habits, and rarely a rash. As with any supplement, echinacea is not meant to be used consistently as an everyday medication. It should be used when needed or during short seasons to help provide additional immune support or as a therapeutic agent. When used correctly, it can be one of our best helps in reducing inappropriate antibiotic use and helping with URIs.
Citations:
- Burlou-Nagy C, Bănică F, Jurca T, Vicaș LG, Marian E, Muresan ME, Bácskay I, Kiss R, Fehér P, Pallag A. Echinacea purpurea(L.) Moench: Biological and Pharmacological Properties. A Review. Plants. 2022; 11(9):1244. https://doi.org/10.3390/plants11091244
- David S, Cunningham R. Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and meta-analysis. Complement Ther Med. 2019;44:18-26. doi:10.1016/j.ctim.2019.03.011
- Kolev E, Mircheva L, Edwards MR, et al. Echinacea Purpurea For the Long-Term Prevention of Viral Respiratory Tract Infections During Covid-19 Pandemic: A Randomized, Open, Controlled, Exploratory Clinical Study. Front Pharmacol. 2022;13:856410. Published 2022 Apr 26. doi:10.3389/fphar.2022.856410