Use of herbal medicines in children following EBM criteria. Effectiveness and tolerability of echinacea, cranberry, and chamomile

The recent appreciation of phytotherapy is related to the evidence of efficacy of herbal medicines, as well as to the continuous improvement of scientific and clinical knowledge of their effects. Unfortunately among herbal medicine it is frequent to find products that are neither registered nor controlled by regulatory bodies, with a lack of proofs regarding their constituents and quality. Phytotherapy can find its role among medical therapies only if each medication is standardised and controlled according to the requirements of an official Pharmacopoeia, and produced on the basis of Good Manufacturing Practices similar to those used in pharmaceutical companies. This is even more important in paediatric age, also because often parents administer herbal medications to their children, without asking the physician or the pharmacist for advice, being convinced that “natural products” are always safe and do not have adverse events or interactions. The evaluation of these products, ensuring their safety and efficacy through registration and regulation, is an important challenge. To improve an evidence-based and safe use, herbal medicines should be titrated, standardised and labelled. Clinical applications, pharmacology, dosage, possible contraindications and precautions (i.e. during pregnancy, breastfeeding and paediatric age), and potential adverse reactions should be clearly described and codified, for example in the official Pharmacopeia and in the various Monographs (ESCOP, The European Scientific Cooperative On Phytotherapy, and WHO, World Health Organization). The purpose of this article is to provide a review on the safety and efficacy of some medicinal plants widely used in the paediatric age: echinacea, cranberry, and chamomile. The final aim is to help to use herbal medicine on the basis of the criteria of the Evidence Based Medicine.