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ROXANE R. CARR, PHARM.D., is Pediatric Pharmacotherapy Fellow, College of Pharmacy, The Ohio State University, Columbus. MILAP C. NAHATA, PHARM.D., is Professor and Division Chair, Pharmacy Practice and Administration Division, College of Pharmacy, and Professor of Internal Medicine and Pediatrics, College of Medicine, The Ohio State University and Children’s Hospital, Columbus.

Address correspondence to Dr. Nahata at the College of Pharmacy, The Ohio State University, 500 West 12th Avenue, Columbus, OH 43210-1291 (nahata.1{at}osu.edu).

Purpose. Evidence on the efficacy and safety of complementary and alternative medicine (CAM) for the prevention and treatment of upper-respiratory-tract infection (URTI) in children is reviewed. Summary. A search of the literature to June 2005 identified six clinical trials examining the use of herbal medicines and nine trials of other CAM therapies. All articles were critically evaluated for adherence to standards of efficacy and safety research. Echinacea did not reduce the duration and severity of URTI. Andrographis paniculata or echinacea decreased nasal secretions (p < 0.01) but not URTI symptoms. A combination of echinacea, propolis, and ascorbic acid decreased the number of URTI episodes, the duration of symptoms, and the number of days of illness (p < 0.001). Echinacea was associated with a higher frequency of rash compared with placebo (p = 0.008). Neither ascorbic acid nor homeopathy was effective. The efficacy of zinc was not clear, and zinc may be associated with adverse effects in children. Osteopathic manipulation decreased episodes of acute otitis media (p = 0.04) and the need for tympanostomy tube insertion (p = 0.03) in children with recurrent acute otitis media. Stress-management therapy reduced the duration of URTI compared with relaxation therapy with guided imagery or standard care (p < 0.05). Conclusion. Current data are generally inadequate to support CAM for the prevention or treatment of URTI in children. Index terms: Alternative medicine; Andrographis paniculata; Antiinfective agents; Ascorbic acid; Echinacea species; Homeopathy; Minerals; Otitis media; Pediatrics; Plants; Propolis; Respiratory-tract infections; Toxicity; Vitamins; Zinc