Homeopathy in the Age of Antimicrobial Resistance: Is It a Viable Treatment for Upper Respiratory Tract Infections?

Abstract

Background Acute upper respiratory tract infections (URTIs) and their complications are the most frequent cause of antibiotic prescribing in primary care. With multi-resistant organisms proliferating, appropriate alternative treatments to these conditions are urgently required. Homeopathy presents one solution; however, there are many methods of homeopathic prescribing. This review of the literature considers firstly whether homeopathy offers a viable alternative therapeutic solution for acute URTIs and their complications, and secondly how such homeopathic intervention might take place.

Method Critical review of post 1994 clinical studies featuring homeopathic treatment of acute URTIs and their complications. Study design, treatment intervention, cohort group, measurement and outcome were considered. Discussion focused on the extent to which homeopathy is used to treat URTIs, rate of improvement and tolerability of the treatment, complications of URTIs, prophylactic and long-term effects, and the use of combination versus single homeopathic remedies.

Results Multiple peer-reviewed studies were found in which homeopathy had been used to treat URTIs and associated symptoms (cough, pharyngitis, tonsillitis, otitis media, acute sinusitis, etc.). Nine randomised controlled trials (RCTs) and 8 observational/cohort studies were analysed, 7 of which were paediatric studies. Seven RCTs used combination remedies with multiple constituents. Results for homeopathy treatment were positive overall, with faster resolution, reduced use of antibiotics and possible prophylactic and longer-term benefits.

Conclusions Variations in size, location, cohort and outcome measures make comparisons and generalisations concerning homeopathic clinical trials for URTIs problematic. Nevertheless, study findings suggest at least equivalence between homeopathy and conventional treatment for uncomplicated URTI cases, with fewer adverse events and potentially broader therapeutic outcomes. The use of non-individualised homeopathic compounds tailored for the paediatric population merits further investigation, including through cohort studies. In the light of antimicrobial resistance, homeopathy offers alternative strategies for minor infections and possible prevention of recurring URTIs.

Keywords

homeopathy - antimicrobial resistance - upper respiratory tract infections - clinical studies - combination remedies

• References

• 1 Broom A, Broom J, Kirby E. Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing. Soc Sci Med 2014; 110: 81-88
• 2 Hulscher ME, Grol RP, van der Meer JW. Antibiotic prescribing in hospitals: a social and behavioural scientific approach. Lancet Infect Dis 2010; 10: 167-175
• 3 Carlet J. Multi-drug resistant bacteria and antibiotics [Article in French]. Rev Infirm 2013; 192: 17-19
• 4 Gottlieb T, Nimmo GR. Antibiotic resistance is an emerging threat to public health: an urgent call to action at the Antimicrobial Resistance Summit 2011. Med J Aust 2011; 194: 281-283
• 5 WHO. Fact sheet antimicrobial resistance. World Health Organization. 2011. Available at: http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/antibiotic-resistance/factsheets/information-for-everyone . Accessed 30 November 2015
• 6 WHO. Antimicrobial resistance [Internet]. World Health Organisation. 2016. Available at: http://www.who.int/mediacentre/factsheets/fs194/en/ . Accessed December 2, 2017
• 7 European Medicines Agency (EMA) European Food Safety Authority. (EFSA). It's time to reduce, replace and re-think the use of antimicrobials in animals. 2017;(January). Available at: http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2017/01/news_detail_002683.jsp&mid=WC0b01ac058004d5c1 . Accessed December 2, 2017
• 8 Roca I, Akova M, Baquero F. , et al. The global threat of antimicrobial resistance: science for intervention. New Microbes New Infect 2015; 6: 22-29
• 9 Bell IR, Boyer NN. Homeopathic medications as clinical alternatives for symptomatic care of acute otitis media and upper respiratory infections in children. Glob Adv Health Med 2013; 2: 32-43
• 10 Jain A. Does homeopathy reduce the cost of conventional drug prescribing? A study of comparative prescribing costs in general practice. Homeopathy 2003; 92: 71-76
• 11 Rossi E, Crudeli L, Endrizzi C, Garibaldi D. Cost-benefit evaluation of homeopathic versus conventional therapy in respiratory diseases. Homeopathy 2009; 98: 2-10
• 12 Tan T, Little P, Stokes T. ; Guideline Development Group. Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ 2008; 337 DOI: 10.1136/bmj.a437.
• 13 Zanasi A, Mazzolini M, Tursi F, Morselli-Labate AM, Paccapelo A, Lecchi M. Homeopathic medicine for acute cough in upper respiratory tract infections and acute bronchitis: a randomized, double-blind, placebo-controlled trial. Pulm Pharmacol Ther 2014; 27: 102-108
• 14 Siqueira CM, Homsani F, da Veiga VF. , et al. Homeopathic medicines for prevention of influenza and acute respiratory tract infections in children: blind, randomized, placebo-controlled clinical trial. Homeopathy 2016; 105: 71-77
• 15 Malapane E, Solomon EM, Pellow J. Efficacy of a homeopathic complex on acute viral tonsillitis. J Altern Complement Med 2014; 20: 868-873
• 16 Morris PS. Upper respiratory tract infections (including otitis media). Pediatr Clin North Am 2009; 56: 101-117
• 17 Alsarraf R, Jung CJ, Perkins J, Crowley C, Alsarraf NW, Gates GA. Measuring the indirect and direct costs of acute otitis media. Arch Otolaryngol Head Neck Surg 1999; 125: 12-18
• 18 Neuzil KM, Hohlbein C, Zhu Y. Illness among schoolchildren during influenza season: effect on school absenteeism, parental absenteeism from work, and secondary illness in families. Arch Pediatr Adolesc Med 2002; 156: 986-991
• 19 Pichichero ME. Otitis media. Pediatr Clin North Am 2013; 60: 391-407
• 20 Hersh AL, Jackson MA, Hicks LA. ; American Academy of Pediatrics Committee on Infectious Diseases. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics 2013; 132: 1146-1154
• 21 Jain N, Lodha R, Kabra SK. Upper respiratory tract infections. Indian J Pediatr 2001; 68: 1135-1138
• 22 Spurling GK, Del Mar CB, Dooley L, Foxlee R. Delayed antibiotics for symptoms and complications of respiratory infections. Cochrane Database Syst Rev 2004; 18: CD004417
• 23 Sanders S, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2004
• 24 Viksveen P. Antibiotics and the development of resistant microorganisms. Can homeopathy be an alternative?. Homeopathy 2003; 92: 99-107
• 25 Rosenfeld RM, Post JC. Meta-analysis of antibiotics for the treatment of otitis media with effusion. Otolaryngol Head Neck Surg 1992; 106: 378-386
• 26 McCormick DP, Chonmaitree T, Pittman C. , et al. Nonsevere acute otitis media: a clinical trial comparing outcomes of watchful waiting versus immediate antibiotic treatment. Pediatrics 2005; 115: 1455-1465
• 27 Zoorob R, Sidani MA, Fremont RD, Kihlberg C. Antibiotic use in acute upper respiratory tract infections. Am Fam Physician 2012; 86: 817-822
• 28 van Haselen R, Thinesse-Mallwitz M, Maidannyk V. , et al. The effectiveness and safety of a homeopathic medicinal product in pediatric upper respiratory tract infections with fever: a randomized controlled trial. Glob Pediatr Health 2016; 3 DOI: 10.1177/2333794×16654851.
• 29 Steinsbekk A, Bentzen N, Fønnebø V, Lewith G. Self treatment with one of three self selected, ultramolecular homeopathic medicines for the prevention of upper respiratory tract infections in children. A double-blind randomized placebo controlled trial. Br J Clin Pharmacol 2005; 59: 447-455
• 30 Kaushik V, Malik T, Saeed SR. Cochrane review: Interventions for acute otitis externa. Evid Based Child Health 2011; 6: 444-560
• 31 Coco AS, Horst MA, Gambler AS. Trends in broad-spectrum antibiotic prescribing for children with acute otitis media in the United States, 1998-2004. BMC Pediatr 2009; 9 DOI: 10.1186/1471-2431-9-41.
• 32 Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics 2011; 128: 1053-1061
• 33 Davies S, Sugden R. What if antibiotics stopped working? Kings Fund. 2017. Available at: https://www.kingsfund.org.uk/reports/thenhsif/what-if-antibiotics-stopped-working/ . Accessed August 15, 2017
• 34 Venekamp RP, Sanders S, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2013; 1: CD000219
• 35 Smucny J, Fahey T, Becker L, Glazier R. Antibiotics for acute bronchitis. Cochrane Database Syst Rev 2004; CD000245 . Doi:10.1002/14651858
• 36 Petersen I, Johnson AM, Islam A, Duckworth G, Livermore DM, Hayward AC. Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. BMJ 2007; 335: 982-982
• 37 Fleming-Dutra KE, Hersh AL, Shapiro DJ. , et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA 2016; 315: 1864-1873
• 38 Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician 2009; 79: 383-390
• 39 Gerber MA. Diagnosis and treatment of pharyngitis in children. Pediatr Clin North Am 2005; 52: 729-747
• 40 Sommer MOA, Dantas G. Antibiotics and the resistant microbiome. Curr Opin Microbiol 2011; 14: 556-563
• 41 Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010; 340 DOI: 10.1136/bmj.c2096.
• 42 Tacconelli E. Antimicrobial use: risk driver of multidrug resistant microorganisms in healthcare settings. Curr Opin Infect Dis 2009; 22: 352-358
• 43 Fredericks I, Hollingworth S, Pudmenzky A, Rossato L, Syed S, Kairuz T. Consumer knowledge and perceptions about antibiotics and upper respiratory tract infections in a community pharmacy. Int J Clin Pharm 2015; 37: 1213-1221
• 44 Risnes KR, Belanger K, Murk W, Bracken MB. Antibiotic exposure by 6 months and asthma and allergy at 6 years: Findings in a cohort of 1,401 US children. Am J Epidemiol 2011; 173: 310-318
• 45 Marra F, Marra CA, Richardson K. , et al. Antibiotic use in children is associated with increased risk of asthma. Pediatrics 2009; 123: 1003-1010
• 46 Schmitt J, Schmitt NM, Kirch W, Meurer M. Early exposure to antibiotics and infections and the incidence of atopic eczema: a population-based cohort study. Pediatr Allergy Immunol 2010; 21: 292-300
• 47 Abramoicz M, Zuccotti G. Alternatives to fluoroquinolones. JAMA 2016; 316: 1404-1405
• 48 Leibovitz E. The use of fluoroquinolones in children. Curr Opin Pediatr 2006; 18: 64-70
• 49 Fox JC, Szyjkowski RS, Sanderson SO, Levine RA. Progressive cholestatic liver disease associated with clarithromycin treatment. J Clin Pharmacol 2002; 42: 676-680
• 50 Hung IF, Wu AK, Cheng VC. , et al. Fatal interaction between clarithromycin and colchicine in patients with renal insufficiency: a retrospective study. Clin Infect Dis 2005; 41: 291-300
• 51 Bandettini di Poggio M, Anfosso S, Audenino D, Primavera A. Clarithromycin-induced neurotoxicity in adults. J Clin Neurosci 2011; 18: 313-318
• 52 Ernst E. Homeopathy: what does the “best” evidence tell us?. Med J Aust 2010; 192: 458-460
• 53 Fisher P. What is homeopathy? An introduction. Front Biosci (Elite Ed) 2012; 4: 1669-1682
• 54 Ghosh AK. A short history of the development of homeopathy in India. Homeopathy 2010; 99: 130-136
• 55 Piolot M, Fagot JP, Rivière S. , et al. Homeopathy in France in 2011-2012 according to reimbursements in the French national health insurance database (SNIIRAM). Fam Pract 2015; 32: 442-448
• 56 Bornhöft G, Matthiessen PF. Homeopathy in Healthcare – Effectiveness, Appropriateness, Safety, Costs. An HTA report on homeopathy as part of the Swiss Complementary Medicine Evaluation Programme. Heidelberg: Springer-Verlag; 2011
• 57 Gao F, Li M. Systems Thinking: Creative Holism for Managers. [Internet]. Vol. 35, International Journal of General Systems. 2006:489–492. Available at: https://login.e.bibl.liu.se/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=22056802&site=eds-live&scope=site . Accessed December 2, 2017
• 58 Jackson MC. Systems Thinking: Creative Holism for Managers. Chichester, UK: John Wiley & Sons Ltd; 2003
• 59 Lewith G, Robinson N. Integrating complementary and alternative medicine (CAM) and conventional diagnoses. Eur J Integr Med 2016; 8: 879-880
• 60 Thomson P, Jones J, Evans J, Leslie SJ. Factors influencing the use of complementary and alternative medicine and whether patients inform their primary care physician [Internet]. 2012. Available at: https://dspace.stir.ac.uk/handle/1893/3672 . Accessed December 2, 2017
• 61 Gagnon EM, Recklitis CJ. Parents' decision-making preferences in pediatric oncology: the relationship to health care involvement and complementary therapy use. Psychooncology 2003; 12 (05) 442-452
• 62 Crawford NW, Cincotta DR, Lim A, Powell CV. A cross-sectional survey of complementary and alternative medicine use by children and adolescents attending the University Hospital of Wales. BMC Complement Altern Med 2006;6. doi: http://www.ncbi.nlm.nih.gov/pubmed/16670012
• 63 Homeopathy in Healthcare [Internet]. 2012. Available at: http://www.springer.com/medicine/complementary+&+alternative+medicine/book/978-3-642-20637-5 . Accessed November 4, 2017
• 64 Mathie RT, Ramparsad N, Legg LA. , et al. Randomised, double-blind, placebo-controlled trials of non-individualised homeopathic treatment: systematic review and meta-analysis. Syst Rev 2017;6. doi: http://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-017-0445-3 . Accessed December 14, 2017
• 65 Sankar K, Jadhav AP. Nosodes and sarcodes. Indian J Tradit Knowl 2017; 16: 158-163
• 66 Joshi S, Mukerjee S, Vaidya S, Talele G, Chowdhary A, Shah R. Preparation, standardization and in vitro safety testing of Mycobacterium nosodes (Emtact- polyvalent nosode). Homeopathy 2016; 105: 225-232
• 67 Mathie RT, Frye J, Fisher P. Homeopathic Oscillococcinum® for preventing and treating influenza and influenza-like illness. Cochrane Database of Systematic Reviews. 2015; CD001957 . doi: 10.1002/14651858.CD001957.pub6
• 68 Flood RL. The relationship of “systems thinking” to action research. Syst Pract Action Res 2010; 23: 269-284
• 69 Mathie RT. Systematic reviews of RCTs in homeopathy a focused appraisal. Focus Altern Complement Ther 2010; 15: 104-106
• 70 Mathie RT, Lloyd SM, Legg LA. , et al. Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis. Syst Rev 2014; 3 DOI: 10.1186/2046-4053-3-142.
• 71 Mathie RT, Hacke D, Clausen J, Nicolai T, Riley DS, Fisher P. Randomised controlled trials of homeopathy in humans: characterising the research journal literature for systematic review. Homeopathy 2013; 102: 3-24
• 72 Beghi GM, Morselli-Labate AM. Does homeopathic medicine have a preventive effect on respiratory tract infections? A real life observational study. Multidiscip Respir Med 2016; 11 DOI: 10.1186/s40248-016-0049-0.
• 73 Van Wassenhoven M, Goossens M, Anelli M. , et al. Pediatric homeopathy: a prospective observational survey based on parent proxy-reports of their children's health-related quality of life in six European countries and Brazil. Homeopathy 2014; 103: 257-263
• 74 Thinesse-Mallwitz M, Maydannik V, Keller T, Klement P. A homeopathic combination preparation in the treatment of feverish upper respiratory tract infections: an international randomized controlled trial. Forsch Komplement Med 2015; 22: 163-170
• 75 Zanasi A, Cazzato S, Mazzolini M. , et al. Does additional antimicrobial treatment have a better effect on URTI cough resolution than homeopathic symptomatic therapy alone? A real-life preliminary observational study in a pediatric population. Multidiscip Respir Med 2015; 10: 25
• 76 Buskin S, Pilar M, Huckstadt R, Salatino S. Use of natural and homeopathic remedies in children ailments. Clin Manag Issues 2016; 10: 33-48
• 77 Ekins-Daukes S, Helms PJ, Taylor MW, Simpson CR, McLay JS. Paediatric homoeopathy in general practice: where, when and why?. Br J Clin Pharmacol 2005; 59: 743-749
• 78 Rossi E, Bartoli P, Panozzo M, Bianchi A, Da Frè M. Outcome of homeopathic treatment in paediatric patients: an observational study from 1998 to 2008. Eur J Integr Med 2010; 2: 115-122
• 79 Jong MC, Buskin SL, Ilyenko L. , et al. Effectiveness, safety and tolerability of a complex homeopathic medicinal product in the prevention of recurrent acute upper respiratory tract infections in children: a multicenter, open, comparative, randomized, controlled clinical trial. Multidiscip Respir Med 2016; 11: 19
• 80 Ramchandani NM. Homoeopathic treatment of upper respiratory tract infections in children: evaluation of thirty case series. Complement Ther Clin Pract 2010; 16: 101-108
• 81 Fixsen A. Should homeopathy be considered as part of a treatment strategy for otitis media with effusion in children?. Homeopathy 2013; 102: 145-150
• 82 Steinsbekk A, Fønnebø V, Lewith G, Bentzen N. Homeopathic care for the prevention of upper respiratory tract infections in children: a pragmatic, randomised, controlled trial comparing individualised homeopathic care and waiting-list controls. Complement Ther Med 2005; 13: 231-238
• 83 Taylor JA, Jacobs J. Homeopathic ear drops as an adjunct to standard therapy in children with acute otitis media. Homeopathy 2011; 100: 109-115
• 84 Frei H, Thurneysen A. Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution?. Br Homeopath J 2001; 90: 180-182
• 85 Herzberger G, Weiser M. Homeopathic treatment of infections of various origins: a prospective study. Biomed Ther 1997; 15: 123-127
• 86 Rabe A, Weiser M, Klein P. Effectiveness and tolerability of a homoeopathic remedy compared with conventional therapy for mild viral infections. Int J Clin Pract 2004; 58: 827-832
• 87 Haidvogl M, Riley DS, Heger M. , et al. Homeopathic and conventional treatment for acute respiratory and ear complaints: a comparative study on outcome in the primary care setting. BMC Complement Altern Med 2007; 7: 7
• 88 Sih TM, Bricks LF. Optimizing the management of the main acute infections in pediatric ORL: tonsillitis, sinusitis, otitis media. Rev Bras Otorrinolaringol (Engl Ed) 2008; 74: 755-762
• 89 Bellavite P. Homeopathic treatment of otitis media: a literature review. Altern Complement Ther 2008; 14: 246-247
• 90 Trichard M, Chaufferin G, Dubreuil C, Nicoloyannis N, Duru G. Effectiveness, quality of life, and cost of caring for children in France with recurrent acute rhinopharyngitis managed by homeopathic or non-homeopathic general practitioners: a pragmatic, prospective observational study. Dis Manag Health Outcomes 2004; 12: 419-427
• 91 Grimaldi-Bensouda L, Bégaud B, Rossignol M. , et al. Management of upper respiratory tract infections by different medical practices, including homeopathy, and consumption of antibiotics in primary care: the EPI3 cohort study in France 2007-2008. PLoS One 2014; 9: e89990 . doi: 10.1371/journal.pone.0089990
• 92 Friese KH, Zabalotnyi DI. Homeopathy in acute rhinosinusitis: a double-blind, placebo controlled study shows the efficiency and tolerability of a homeopathic combination remedy [Article in German]. HNO 2007; 55: 271-277
• 93 Nayak C, Singh V, Singh VP. , et al. Homeopathy in chronic sinusitis: a prospective multi-centric observational study. Homeopathy 2012; 101: 84-91
• 94 Sharma SR, Murty KB, Sahagal GC, Sharma B, Bharatalaxmi KSV. Clinical evaluation of homoeopathic medicines in sinusitis. Indian J Res Homoeopath [Internet]. 2008; 2: 26-37
• 95 Witt CM, Lüdtke R, Willich SN. Homeopathic treatment of patients with chronic sinusitis: a prospective observational study with 8 years follow-up. BMC Ear Nose Throat Disord 2009; 9: 7
• 96 Palm J, Kishchuk VV, Ulied À. , et al; TocTo Research Group. Effectiveness of an add-on treatment with the homeopathic medication SilAtro-5-90 in recurrent tonsillitis: an international, pragmatic, randomized, controlled clinical trial. Complement Ther Clin Pract 2017; 28: 181-191
• 97 Friese K, Timen G, Zabalotnyi D. Homeopathy in children with nonstreptococcal tonsillitis. Study proves efficacy and tolerability of a homeopathic combination medicine. Der Kassenarzt 2006; 6: 4042
• 98 Sinha MN, Siddiqui VA, Nayak C. , et al. Randomized controlled pilot study to compare homeopathy and conventional therapy in acute otitis media. Homeopathy 2012; 101 (01) 5-12
• 99 Jong MC, Verwer C, van de Vijver L, Klement P, Burkart J, Baars E. A randomized open comparative clinical trial on the effectiveness, safety and tolerability of a homeopathic medicinal product for the treatment of painful teething in Children. Altern Integr Med 2015; 4: 1-9
• 100 Kok ET, Jong MC, Gravendeel B, Van Leeuwen WB, Baars EW. Resistance to antibiotics and antifungal medicinal products: can complementary and alternative medicine help solve the problem in common infection diseases?. The introduction of a Dutch research consortium. Evid Based Complement Altern Med. 2015. doi: http://dx.doi.org/10.1155/2015/521584
• 101 Jacobs J, Taylor JA. A randomized controlled trial of a homeopathic syrup in the treatment of cold symptoms in young children. Complement Ther Med 2016; 29: 229-234
• 102 Schmiedel V, Klein P. A complex homeopathic preparation for the symptomatic treatment of upper respiratory infections associated with the common cold: An observational study. Explore (NY) 2006; 2: 109-114
• 103 Mathie RT, Van Wassenhoven M, Jacobs J. , et al. Model validity and risk of bias in randomised placebo-controlled trials of individualised homeopathic treatment. Complement Ther Med 2016; 25: 120-125
• 104 Access to Medicine Foundation. Antimicrobial Resistance Benchmark 2018. Methodology 2017. Available at: http://accesstomedicinefoundation.org . Accessed October 12, 2017
• 105 Mathie RT, Fisher P. Homeopathy is safe and does not lack positive evidence in clinical trials. Br J Clin Pharmacol 2007; 64: 396-397 , author reply 398–399
• 106 Fisher P, Berman B, Davidson J, Reilly D, Thompson T. Are the clinical effects of homoeopathy placebo effects?. Lancet 2005; 366: 2082-2083 , author reply 2083–2086
• 107 Linde K, Clausius N, Ramirez G. , et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: 834-843