Antibiotics have saved millions of lives, and alleviated much pain and suffering over the past 80 years. However, antibiotic resistance is one of the most life-threatening health care concerns globally and presents an alarming challenge for modern medicine and clinicians today. Over the past 25 years, the landscape of antimicrobial resistance has changed considerably. The geographic locations of resistant bacteria have extended, and the breadth of resistance increased globally. There appears to be a direct relationship between the use of antibiotics and the development of resistance.

A role for Herbal medicine?

The use of plants as therapeutic agents is as old as humankind itself, and prior to the introduction of chemical antimicrobial agents and antibiotics, phytomedicinal preparations were the principle methods used to treat infections in humans.

Evidence exists that appropriate phytotherapy could be usefully applied as a preventive or first line treatment for many common infections, thus avoiding the need for antibiotic medication in many cases.

As many as 80% of human bacterial infections are associated with structured microbial communities known as biofilms, and residence within the protection of a biofilm gives pathogens an increased tolerance to antibiotics and protection from the immune response. This is a major problem which increases infection severity and persistence, and therapies that target biofilm formation and architecture, are therefore urgently required. Many plant extracts and phytochemicals as well as essential oils and honey, have to date shown promising potential to impede biofilm formation.

Respiratory Tract Infections

While most URTI’s are attributable to viruses such as influenza or rhinoviruses, serious or secondary bacterial infections can occur, and antibiotic or other antibacterial treatments are sometimes required.

Evidence for the therapeutic benefits of most common cough syrups is limited, and opiate or antihistamine based products are frequently associated with adverse events. However, compelling evidence now exists that honey can reduce the severity of nocturnal coughs in children. There is also good evidence that herbs such as Echinacea and Thyme can improve symptoms of or shorten the duration of coughs due to respiratory tract infections. Use of honey-based products containing these or other herbs traditionally used for upper respiratory tract infections such as Hyssop, Elecampane(, Marshmallow(, Garlic, Horseradish or Peppermint, can also provide relief to some patients, and help avoid the need for drug-based products.

Immune enhancement

Echinacea is currently used largely as a prophylactic for treatment of colds and influenza, although herbal practitioners use it for treating other infectious and inflammatory conditions. Alkylamides are now regarded as the major bioavailable and active immunomodulatory components in oral forms of Echinacea, highest levels of which are found in the root.

Apart from ongoing work to evaluate phytomedicines as infection prophylactics and stand-alone treatments, an area which offers the greatest potential in the near term, is in the application of plant extracts or phytochemical preparations as adjunctive therapy with antibiotic drugs. The logic of this approach is obvious, from both treatment outcome and cost-saving perspectives, and similar outcomes to that achieved through carefully selected combinations of drugs such as probenecid with antibiotics, may be achieved.