Mixing Antibiotics and Herbs For Better Overall Health

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Antiviral and anti-inflammatory herbs, such as astragalus (above), are helpful for upper-respiratory infections.
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Antiviral and anti-inflammatory herbs, such as astragalus (above), are helpful for upper-respiratory infections.

It’s a common question, one that I’m likely to hear on any given day in my family practice: “Doc, I’ve had this bad cold for weeks. I’ve been coughing a lot, my throat is sore, and my nose has been draining thick, yellow mucus. Do you think that I might need to take an antibiotic?”

This may seem like a simple question, but answering it accurately requires knowing whether the infection is caused by bacteria (and, therefore, can be cured by antibiotics) or by a virus (which cannot). It is also helpful to know whether the patient has already tried any herbs or supplements as a first line of treatment.

Under pressure to avoid extra laboratory fees and to avoid making their patients endure another three to four days of discomfort while waiting for test results, doctors often choose to go ahead and prescribe antibiotics, “just in case” the infection is bacterial. That choice is often inappropriate: Except for strep throat (caused by streptococcal bacteria), upper-respiratory infections such as bad colds, bronchitis, sore throats, or sinusitis are almost always caused by a virus. Consequently, the Centers for Disease Control and Prevention estimates that every year as many as 50 million unnecessary prescriptions are written for antibiotics.

A bacteria fighter

Part of the quandary faced by many conventional medical doctors stems from a belief that if there is any chance bacteria are responsible for the symptoms, then treatment with an antibiotic is the only legitimate option; botanical medicines and other alternative therapies aren’t even worthy of consideration. It isn’t hard to understand the origins of this belief. Only a hundred years ago, the top three causes of death in the United States were pneumonia, gastrointestinal infections, and tuberculosis–all bacterial infections.

Most of the standard treatments for these diseases were ineffective. But about seventy years ago, something happened that dramatically changed this situation: Sir Alexander Fleming discovered penicillin, and the era of antibiotics was born. Given their effectiveness for treating illnesses that in the past were often life-threatening, it’s no wonder that penicillin, the sulfa drugs that followed soon after, and eventually a panoply of infection-fighting medications were all perceived as magic bullets that could be used to treat any and all infections. When compared to such powerful weapons, the popular herbal remedies of the day, such as garlic (Allium sativum), echinacea (Echinacea spp.), and goldenseal (Hydrastis canadensis) were viewed as sideshow nostrums and cast aside.

Problems with antibiotics

As we enter a new millennium, times are changing once again. Antibiotics are no longer seen as a risk-free panacea. Their rampant overuse has created resistant strains of bacteria that are not so easy to treat. Antibiotics have also been found to have serious side effects such as allergic reactions, colitis, and yeast overgrowth. These problems have opened the door to creative alternative solutions for dealing with infectious disease. Ironically, one of the solutions to this modern-day problem might be found in the age-old realm of botanical medicine.

Herbs are increasingly gaining respect in scientific circles. Researchers have identified numerous biologically active ingredients in plants, including allicin in garlic, arabinogalactan in echinacea, and berberine in goldenseal. The plant kingdom appears to be bursting from the soil with a diverse array of biological response modifiers–compounds that have been shown to boost immunity and help fight off infection with fewer and milder side effects than antibiotics. The catch is that herbs are not as potent and don’t work as quickly as antibiotics. This is one of the reasons they have been discounted in the past. However, an integrated approach can make the best of both worlds.

A synergistic relationship

Clinical research has shown that certain herbs can act synergistically with antibiotics to speed recovery from infection. In a German study, a proprietary combination of echinacea, white cedar (Thuja occidentalis), and wild indigo root (Baptisia tinctoria) was used along with standard antibiotic therapy to treat bacterial tonsillitis. The group who received this treatment was compared to a group who received antibiotics alone. In this multicenter trial involving more than 4,000 patients, those who received the herbal preparation along with the antibiotics were found to heal more rapidly, and with a lower incidence of recurrence. Another German study conducted by an ear, nose, and throat specialist investigated the effect of adding this same herbal preparation to an antibiotic for patients with acute sinusitis–a condition that can require several weeks of treatment. Patients were re-evaluated at ten days and again at twenty days. Based on X-ray findings and symptom scores, the thirty patients who received the combination therapy responded much better than the thirty who received only an antibiotic.

While advocates of a strictly pharmaceutical approach to treating disease are often at odds with those who recommend a “natural” approach to health care, studies such as these suggest that a collaboration can provide more effective options. Herbal medicines may not replace antibiotics, but many of them possess anti-inflammatory and antiviral properties, which make them a much better choice in the initial stages of an upper-respiratory infection. Several studies support the use of herbs such as echinacea, andrographis (Andrographis paniculata), and astragalus (Astragalus membranaceus) in this situation. Olive leaf extract (Olea europaea), which in laboratory studies has been found to kill both viruses and bacteria, also shows great promise.

Combining herbs and antibiotics

If the person’s condition worsens and a bacterial “superinfection” develops, then antibiotics can be added to the regimen with the knowledge that the combination of treatments may be more effective than either one alone. This same principle of starting with herbs and adding an antibiotic if things don’t improve in a few days can be applied to all kinds of minor infections, whether they are viral or bacterial in nature. For example, my initial treatment for a bladder infection might be uva ursi (Arctostaphylos uva-ursi) tincture, but I wouldn’t hesitate to add a sulfa drug to the mix if symptoms don’t resolve. I typically treat a case of acute diarrhea with berberine extract, but also obtain a stool culture before starting the herb. If the berberine doesn’t do the trick, the culture results can help me decide whether an antibiotic is necessary. Perhaps the day will come when medical texts (and public health officials) seamlessly integrate recommendations for herbal medicines and antibiotics as treatment for all kinds of infection. Until then, we’ll have to cross each bridge as we find it. But isn’t that how medicine has been practiced since the dawn of time?

Robert Rountree, M.D., is a physician in private practice in Boulder, Colorado, where he practices integrative medicine. He is co-author of Smart Medicine for a Healthier Child (Avery, 1994) and Immunotics (Putnam, 2000), and is an Herb Research Foundation advisory board member.


Barrett, B., et al. “Echinacea for upper respiratory infection.” Journal of Family Practice 1999, 48(8): 628-635.

Hou, Y., et al. “Effect of radix astragali seu heysari on the Interferon system.” Chinese Medical Journal 1981, 94(1): 35-40.

Melchior, J., et al. “Double-blind, placebo-controlled pilot and phase III study of activity of standardized Andrographis paniculata Herba Nees extract fixed combination in the treatment of uncomplicated upper-respiratory tract infection.” Phytomedicine 2000, 7(5): 341-350.

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