TY - JOUR PB - MDPI AG ID - discovery10191615 UR - https://doi.org/10.3390/antibiotics13040364 N2 - Respiratory tract infections (RTIs) are the leading cause of antibiotic prescriptions, primarily due to the risk for secondary bacterial infections. In this study, we examined whether Echinacea could reduce the need for antibiotics by preventing RTIs and their complications, and subsequently investigated its safety profile. A comprehensive search of EMBASE, PubMed, Google Scholar, Cochrane DARE and clinicaltrials.gov identified 30 clinical trials (39 comparisons) studying Echinacea for the prevention or treatment of RTIs in 5652 subjects. Echinacea significantly reduced the monthly RTI occurrence, risk ratio (RR) 0.68 (95% CI 0.61?0.77) and number of patients with ?1 RTI, RR = 0.75 [95% CI 0.69?0.81] corresponding to an odds ratio 0.53 [95% CI 0.42?0.67]. Echinacea reduced the risk of recurrent infections (RR = 0.60; 95% CI 0.46?0.80), RTI complications (RR = 0.44; 95% CI 0.36?0.54) and the need for antibiotic therapy (RR = 0.60; 95% CI 0.39?0.93), with total antibiotic therapy days reduced by 70% (IRR = 0.29; 95% CI 0.11?0.74). Alcoholic extracts from freshly harvested Echinacea purpurea were the strongest, with an 80% reduction of antibiotic treatment days, IRR 0.21 [95% CI 0.15?0.28]. An equal number of adverse events occurred with Echinacea and control treatment. Echinacea can safely prevent RTIs and associated complications, thereby decreasing the demand for antibiotics. Relevant differences exist between Echinacea preparations. TI - Echinacea Reduces Antibiotics by Preventing Respiratory Infections: A Meta-Analysis (ERA-PRIMA) N1 - Copyright © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). JF - Antibiotics SN - 2079-6382 KW - Echinacea; prevention; respiratory tract infections; antibiotics; recurrent RTIs; complications IS - 4 A1 - Gancitano, Giuseppe A1 - Mucci, Nicola A1 - Stange, Rainer A1 - Ogal, Mercedes A1 - Vimalanathan, Selvarani A1 - Sreya, Mahfuza A1 - Booker, Anthony A1 - Hadj-Cherif, Bushra A1 - Albrich, Werner A1 - Woelkart-Ardjomand, Karin A1 - Kreft, Samo A1 - Berghe, Wim Vanden A1 - Hoexter, Godehard A1 - Schapowal, Andreas A1 - Johnston, Sebastian AV - public VL - 13 Y1 - 2024/04// ER -