The overuse of antibiotics is a major issue, leading to antibiotic resistance and higher risk of major health issues and death. Here we share how herbalism can help.
Antibiotics are group of drugs that have the ability to kill or inhibit the growth of bacteria, with the aim of treating bacterial infections in humans and animals (1). Antibiotic resistance occurs when specific antibiotics lose their efficacy against bacteria (2). Some bacteria possess inherent resistance to certain antibiotics, while a more concerning issue arises when bacteria that are typically susceptible to antibiotics, develop resistance due to genetic mutations (2). Genetic mutations happen when bacteria that survive antibiotic use, pass on the genes that have allowed them to remain alive. Infections caused by resistant bacteria often need intensified care and the use of alternative, costlier antibiotics that can sometimes have more severe side effects (2).
The more antibiotics are used, the less effective they become against their target microorganisms. Antibiotic overprescribing occurs when healthcare providers prescribe antibiotics unnecessarily, such as for viral infections or conditions where antibiotics offer little or no benefit (3). In the NHS, as in many healthcare systems globally, overprescribing is a significant problem that is contributing to the emergence of antibiotic-resistant bacteria, posing a significant challenge to public health (3, 4). According to the World Health Organization (WHO), antibiotic resistance is one of the biggest threats to global health, food security, and development today (5). If no action is taken, antimicrobial resistance could cause up to 10 million deaths annually by 2050, matching the same annual deaths as caused by cancer (6).
According to the UK government’s 2019-2020 English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report, antibiotic prescribing rates in the UK remain high, particularly in primary care settings (3). Overprescribing of antibiotics in primary care is one of the main drivers of antimicrobial resistance internationally (8). Some studies have estimated that between 20-33% of antibiotic prescriptions in primary care in the UK and the US are unnecessary or inappropriate (4, 7).
In response to this crisis, healthcare systems like the NHS are implementing strategies to reduce unnecessary antibiotic prescriptions and shorten the duration of antimicrobial courses (9).
To support this endeavour, it is important to highlight the role that herbal medicine can play in decreasing antibiotic overprescribing. Herbal medicine can support and mitigate the problem of antibiotic overprescribing by providing safe, effective, and sustainable alternatives for treating infections (10). By harnessing the antimicrobial properties of herbs and promoting herbal self-care practices, healthcare systems can reduce reliance on antibiotics, mitigate the threat of antibiotic resistance, and improve patient outcomes. Some benefits of reducing antibiotic overprescribing with the support of herbal medicine include reducing the risk of toxicity and adverse drug reactions, reducing antimicrobial, and reducing the disruption of normal gut microbiota and with this, reducing the risk of opportunistic infections with bacteria such as Clostridium difficile (10).
Collaboration between herbalists and doctors is key to realising the full potential of herbal medicine in treating infectious diseases and promoting holistic health.
The role of herbs and herbalists
Medical herbalists can support doctors in addressing antibiotic overprescribing and length of antibiotic course by offering alternative and sometimes complementary therapeutical options to eradicate infections as well as to improve the individual’s immune system. Herbalists can develop individualised herbal protocols tailored to each patient’s unique health needs (11).
Herbalists have therapeutic tools for conditions that are often unnecessarily treated with antibiotics, such as some respiratory infections, urinary tract infections, mild superficial skin infections, and digestive complaints (11). Herbs, as well as dietary changes, and lifestyle modifications can often be effective in managing these conditions without the need of antibiotics (12). Herbalists can also offer supportive care to patients who are already taking antibiotics, helping to mitigate potential side effects, and improving immune function.
Herbs have several actions that enable them to be useful in the prevention and treatment of infections.
- Anti septic: prevents the growth of microorganisms
- Antimicrobial: shows activity against any microorganism – bacteria, viruses, fungi, parasites
- Anti-bacterial: can kill or inhibit the growth of bacteria (e.g. streptococcus)
- Anti-viral: can kill or inhibit the growth of viruses (e.g. influenza, coronavirus)
- Immune modulating: can stimulate immunity or improve immune cell function
There are many herbs and medicinal plants with antimicrobial properties that can help fight infections. These are some examples:
Garlic (Allium sativum) contains allicin, a phytochemical compound that is released when cloves are crushed. Allicin has potent antibacterial, antiviral and antifungal properties, making it effective against a wide range of pathogens, including coronavirus (13). Garlic can be particularly useful to help upper and lower respiratory infections as it has shown effectiveness against Klebsiella pneumonia, Staphylococcus aureus, Streptococcus pneumonia and Pseudomonas aeruginosa (14). Some studies have also shown that garlic can inhibit the growth antibiotic-resistant bacteria such as MRSA (Methicillin-resistant Staphylococcus aureus) (14, 15).
The root of Echinacea (Echinacea angustifolia and purpurea) is another medicinal plant commonly used to improve immune system function and prevent infections (11). Echinacea has been found effective against enveloped respiratory viruses, such as influenza, respiratory syncytial virus (RSV), and coronaviruses like SARS-CoV-2 (16, 17). It also has antibacterial properties, inhibiting growth of a wide range of bacteria including Streptococcus pyogenes, Haemophilus influenza or Klebsiella pneumonia (18, 19). Echinacea is also an immune-modulator, as it can activate interferon signalling, chemotaxis (immune cell migration to specific sites of needed action) and it is anti-inflammatory (11). A meta-analysis published in 2024 showed that Echinacea reduced the risk of recurrent respiratory tract infections, respiratory tract infection complications and reduced the need for antibiotic therapy (20). It showed a 70% reduction of total antibiotic therapy days. Specifically, this meta-analysis showed the most effective preparation to be the alcoholic extract (tincture) of freshly harvested Echinacea purpurea root (20).
Elderberry (Sambucus nigra) is another medicinal plant that can be effective in respiratory infections. Elderberry has antiviral properties and in combination with other herbs, it has got potential to treat viral respiratory conditions such as viral tonsilitis, colds and flu, where sometimes antibiotics are inappropriately prescribed (21).
Uva ursi (Arcostaphylus uva ursi) is a urinary antiseptic and urinary antimicrobial that has shown specific antibacterial action against bacteria causing urinary tract infections such as Escherichia coli and Staphylococcus saprophyticus (22, 23). Herbalists usually combine uva ursi with urinary demulcents that sooth irritated urinary tract membranes, such as marshmallow root or corn silk (11, 12).
Andrographis is a very powerful plant to support the immune system, and is a potent antiviral too. Studies show that it positively modulates the immune cells and is particularly helpful for respiratory infections, and it shortens the duration and severity of illness (32).
Kitchen herbs like ginger, thyme and oregano also exhibit potent antimicrobial properties. Ginger (Zingiber officinale) exhibits antimicrobial activity against bacteria, viruses, and fungi, making it useful for treating respiratory and gastrointestinal infections (12, 24). Herbs like thyme (Thymus vulgaris) and oregano (Origanum vulgare) contain volatile oils that confer them strong antimicrobial activity (25, 26).
Herbal self-care practices
Encouraging herbal self-care practices fosters a connection between individuals and their health. Embracing herbal remedies offers a natural alternative and cultivates a sense of self-reliance, reducing dependence on antibiotics.
Incorporating herbal teas, supplements, tinctures, and topical applications into daily routines can be very useful. For instance, honey has potent antibacterial properties both internally and externally, offering an easy to reach therapeutic tool. A simple blend of honey and crushed garlic is a powerful remedy that will help fighting off infections (27). Good quality honey can also be applied topically on the skin to prevent the infection of burns and ulcers (28). Corn silk (Zea mays) tea, coupled with ample hydration, both soothes and eases urinary tract infections (12).
Essential oils and phenolic compounds of sage (Salvia officinalis) have shown antibacterial action against pathogens affecting the oral mucosa and throat, including gram-positive and gram-negative bacteria (29). Sage is an easy herb to get hold of, and making a simple sage infusion for gargling can help to eliminate harmful pathogens in the throat and mouth, as well as sooth sore throats (30).
Steam inhalation can be an excellent way to ease congestion and help with feelings of anxiety and stress. Herbs such as eucalyptus, sage, thyme and rosemary contain antimicrobial essential oils that will help with respiratory congestion and infection (26, 31). A simple recipe is as follows:
Add to a big bowl:
- 20 drops of rosemary essential oil
- 20 drops of eucalyptus essential oil
- 20 drops of juniper essential oil
- 1 litre of boiled water
Place your face over the bowl, cover your head with a cloth or towel, and inhale deeply.
If you have access to the dry or fresh herbs rather than the essential oils, you could make a strong tea with equal parts of each herb. Place all herbs in a bowl with one to two litres of water and bring to boil for a few minutes.
The importance of education and collaboration
Collaboration between herbalists and doctors is essential for integrating herbal medicine and mainstream healthcare and reducing antibiotic overprescribing. Doctors can learn from herbalists’ expertise in botanical medicine and recommend herbal self-care or refer to medical herbalists where appropriate. This interdisciplinary approach allows for personalised care that addresses the unique needs of each patient while minimising the use of antibiotics.
References
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- Krockow EM, Harvey EJ, Ashiru-Oredope D. Addressing long-term and repeat antibiotic prescriptions in primary care: considerations for a behavioural approach. BMJ Quality & Safety. 2022;31(11):782-786.
- Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States, 2019. Available from: https://www.cdc.gov/drugresistance/biggest-threats.html](https://www.cdc.gov/drugresistance/biggest-threats.html. Published 2020.
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- Mösbauer K, Fritsch VN, Adrian L, Bernhardt J, Gruhlke MCH, Slusarenko AJ, et al. Allicin inhibits SARS-CoV-2 replication and abrogates the antiviral host response in the Calu-3 proteome. BioRxiv. 2021-05.
- Farrag HA, Hosny AEDM, Hawas AM, Hagras SA, Helmy OM. Potential efficacy of garlic lock therapy in combating biofilm and catheter-associated infections; experimental studies on an animal model with focus on toxicological aspects. Saudi Pharmaceutical Journal. 2019;27(6):830-840.
- Li G, Ma X, Deng L, Zhao X, Wei Y, Gao Z, et al. Fresh garlic extract enhances the antimicrobial activities of antibiotics on resistant strains in vitro. Jundishapur journal of microbiology. 2015;8(5).
- Pleschka S, Stein M, Schoop R, Hudson JB. Anti-viral properties and mode of action of standardized Echinacea purpurea extract against highly pathogenic avian influenza virus (H5N1, H7N7) and swine-origin H1N1 (S-OIV). Virology journal. 2009;6:1-9.
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- Moghtaderi M, Mirzaie A, Zabet N, Moammeri A, Mansoori-Kermani A, Akbarzadeh I, et al. Enhanced antibacterial activity of Echinacea angustifolia extract against multidrug-resistant Klebsiella pneumoniae through niosome encapsulation. Nanomaterials. 2021;11(6):1573.
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- Gancitano G, Mucci N, Stange R, Ogal M, Vimalanathan S, Sreya M, et al. Echinacea Reduces Antibiotics by Preventing Respiratory Infections: A Meta-Analysis (ERA-PRIMA). Antibiotics. 2024;13(4):364.
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