A systematic review of the efficacy of herbal medicines in the treatment of acute diarrhea

Abstract

Acute diarrhea is a global health challenge, especially in developing regions. It accounted for 444,000 child mortalities in 2021, and indiscriminate use of antibiotics in its management is reported to contribute significantly to increase in antibiotic resistance. The objective of this study was to identify herbal drugs which are efficacious in acute diarrhea treatment. This systematic review assessed the efficacy of herbal medicines in treating acute diarrhea through the analysis of randomized controlled trials. The review followed PRISMA and the Cochrane Handbook guidelines. Literature search was performed in PubMed, CINAHL, Web of Science, Scopus, Cochrane Central, and a clinical trial registry for studies involving human subjects with acute diarrhea and herbal medicine (HM) interventions. Primary outcome measures included stool consistency, stool frequency, duration of diarrhea, abdominal pain, nausea and vomiting, and pyrexia. The search found 2581 articles, of which 9 involving 916 participants (72% children, 27% adults) were analyzed. The studies span 1976–2022, and assessed: Boswellia serrata (Indian frankincense), Rheum ribes L. (rhubarb), Camellia sinensis (black tea), Potentilla tormentilla (Septfoil), apple pectin-chamomile extract, kaolin-pectin, Dirasif (multi-herbal preparation), Psidium guajava (guava folia), and Dowdo (wheat and milk herbal feed). The studies had varying participant age ranges, diarrhea causes, and risks of bias. Only C. sinensis was able to reduce stool consistency, while R. ribes and B. serrata reduced diarrhea duration significantly. Other HMs had positive effects on abdominal pain, nausea and vomiting, and pyrexia. Studies on C. sinensis B. serrata extract, R. ribes, and P. tormentilla extract demonstrated significant efficacy and, low to moderate risk of bias.