Role of Echinacea in the management and prevention of acute respiratory tract infections in children: A systematic review of the evidence.

2025-10
Journal of family & community medicine 32(4)
- Ahlam Mazi
- Reem M Alqahtani

PubMed: 41234257
DOI: 10.4103/jfcm.jfcm_144_25

Study Design

Type: Review
Population: children
Methods: systematic review of randomized controlled trials; searched PubMed, Cochrane Library, Semantic Scholar, and Google Scholar on October 15, 2024; five studies met criteria for qualitative synthesis

Acute cough and respiratory tract infections (RTIs), common in children, often lead to high antibiotic use. Echinacea, an herbal alternative, has been studied for its immune-modulating and antiviral effects to reduce the unnecessary use of antibiotics. This systematic review analyzed randomized controlled trials on Echinacea for pediatric acute cough and RTIs. PubMed, Cochrane Library, Semantic Scholar, and Google Scholar were searched on October 15, 2024. Five studies met all inclusion criteria and were retained for qualitative synthesis. The studies generally showed some concerns of bias in randomization and allocation concealment, as well as some issues about blinding and selective reporting. Grading of recommendations assessment, development, and evaluation assessment indicated high certainty of the reduction of symptom duration and antibiotic use, and moderate certainty for the prevention of infection. Evidence suggests that Echinacea purpurea, especially at higher doses (e.g., 2000 mg/day), may reduce RTI incidence, viral load, and symptom severity. Several trials have reported fewer antibiotic prescriptions and shorter fever duration, indicating public health benefits. Efficacy varied by formulation, extraction, and dosing, with tablet-based and hydroethanolic extracts showing more consistent results. Echinacea was well tolerated, only producing mild adverse effects of gastrointestinal discomfort and skin rashes. Some studies showed no significant difference from placebo, which underlines the need for standardized dosing and formulation. Overall, Echinacea may be a useful adjunct for pediatric RTI prevention and management, but further large, high-quality trials are needed to confirm optimal use, efficacy, and safety.

Research Insights

Echinacea→Reduced Antibiotic Use
Grading of recommendations assessment, development, and evaluation assessment indicated high certainty of the reduction of symptom duration and antibiotic use
Effect
Beneficial
Effect size
Small
Dose
not stated
Echinacea→Reduced Antibiotic Use
Grading of recommendations assessment, development, and evaluation assessment indicated high certainty of the reduction of symptom duration and antibiotic use
Effect
Beneficial
Effect size
Small
Dose
not stated
Echinacea→Reduced Fever Duration
Several trials have reported fewer antibiotic prescriptions and shorter fever duration, indicating public health benefits.
Effect
Beneficial
Effect size
Small
Echinacea→Reduced Infection Incidence
and moderate certainty for the prevention of infection.
Effect
Neutral
Effect size
Small
Dose
2000 mg/day
Echinacea→Reduced Infection Incidence
and moderate certainty for the prevention of infection.
Effect
Neutral
Effect size
Small
Dose
2000 mg/day
Echinacea→Reduced Symptom Duration
Grading of recommendations assessment, development, and evaluation assessment indicated high certainty of the reduction of symptom duration and antibiotic use
Effect
Beneficial
Effect size
Small
Echinacea→Reduced Symptom Severity
Some studies showed no significant difference from placebo
Effect
Neutral
Effect size
Small
Dose
2000 mg/day
Echinacea→Reduced Symptom Severity
Some studies showed no significant difference from placebo
Effect
Neutral
Effect size
Small
Dose
2000 mg/day
Echinacea→Reduced Viral Load
Evidence suggests that Echinacea purpurea, especially at higher doses (e.g., 2000 mg/day), may reduce RTI incidence, viral load, and symptom severity.
Effect
Beneficial
Effect size
Moderate
Dose
2000 mg/day

Adverse Events Reported

Echinacea→gastrointestinal discomfort
Echinacea was well tolerated, only producing mild adverse effects of gastrointestinal discomfort and skin rashes.
Finding
Reported
Grade
mild
Echinacea→skin rashes
Echinacea was well tolerated, only producing mild adverse effects of gastrointestinal discomfort and skin rashes.
Finding
Reported
Grade
mild