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Am Fam Physician. 2004;70(1):175

The average child has six to eight colds per year, each lasting seven to nine days; nearly 40 percent of all visits to pediatricians by children one to five years of age are for symptoms of upper respiratory infections (URIs). These visits often result in antibiotic prescriptions or advice to use decongestants, antihistamines, and cough suppressants, even though the evidence supporting the efficacy of these medications in children is scant. Echinacea has been used extensively for prevention and treatment of URIs. To determine whether echinacea is safe and effective in children, Taylor and colleagues conducted a randomized controlled trial, postulating that echinacea would reduce the duration of URI symptoms by at least one and one half to two days in children two to 11 years of age.

Healthy children were recruited through a physicians’ network and at health care clinics and naturopathic offices. Children were enrolled for a four-month period and randomized to treatment with echinacea syrup or placebo syrup. Parents were asked to immediately contact a study coordinator to confirm the presence of at least two URI symptoms in their children. Then they were to begin administering medication, recording their child’s symptoms in a logbook using a four-point Likert scale to assess the severity of symptoms. Parents were not to use any medications other than the study drug and acetaminophen, unless prescribed by a physician. Primary outcomes were duration and severity of URIs and adverse events. Secondary outcomes included peak severity of the URI, number of days at peak severity, number of days with fever, and overall parental assessment of the URI severity.

Of the 524 children enrolled in the study, 92.7 percent contributed data on at least one URI or completed the study without any URI symptoms. Logbook data were collected on 707 URIs that occurred in 407 children; 370 infections were treated with placebo, and 337 infections were treated with echinacea. There were no statistically significant differences between the groups for duration or severity of symptoms, peak severity of symptoms, number of days of peak symptoms, number of days of fever, or parental global assessment of the severity of the cold. This lack of difference remained when data were analyzed for different age groups. The rates of adverse events did not differ between the two groups. The number of parents in both groups who guessed whether their children had received echinacea or placebo, or who were uncertain, was similar. Fewer patients who had used echinacea had subsequent URIs in the study period, and this difference was statistically significant.

Echinacea, when taken in the dosage used in this study, did not show any benefit over placebo. Other dosages, dosing frequencies, and different formulations of the echinacea medication could potentially alter these results. It also is possible that echinacea might prevent subsequent URIs. However, this paticular study was not designed to evaluate this effect.

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