Evaluating the therapeutic efficacy, tolerability, and safety of an aqueous extract of Costus speciosus rhizome in acute pharyngitis and acute tonsillitis

Objectives: To determine the efficacy, tolerability, and safety of an aqueous extract of Costus speciosus (C. speciosus) rhizome in pediatric and adult patients suffering from acute pharyngitis and tonsillitis as an alternative to antibiotics use. Methods: This pilot cohort trial was conducted at King Abdulaziz University in Saudi Arabia between May and December 2014, among 15 patients with acute pharyngitis and tonsillitis who were administered nasal drops of aqueous extract of C. speciosus rhizome at a dose of 15-30 drops every 8 hours for 3 days. The primary outcome measure was the clinical improvement and remission rate within the first 5 days. Results: The administration of C. speciosus resulted in an improvement in acute symptoms in 60% of the patients treated within the first 24 hours, and remission rate of 93% by day 5, without any recorded adverse effects. Conclusion: This study revealed a significant efficacy of the aqueous extract of C. speciosus rhizome in acute pharyngitis and tonsillitis. Saudi Med J 2015; Vol. 36 (8): 997-1000 doi: 10.15537/smj.2015.8.11377 T overuse of antibiotics in respiratory tract infections is considered to be a significant cause of antibiotic resistance in the community.1 However, acute pharyngitis is a self-limiting disease, and antibiotics are indicated only if the patient has not improved over a period of time. This strategy to delay prescription is likely to provide similar benefits to an immediate antibiotic prescription, with the benefit of decreasing the overuse of antibiotics.2 Furthermore, the antibiotics may cause a range of adverse effects including gastrointestinal manifestations, skin allergy, hepatic toxicity, anaphylactic reaction, and neuropsychiatric problems.3 Phytomedicine will only become incorporated into orthodox medicine, which is defined as the practice of medicine where the disease is viewed as a physical disorder with little relationship to the person’s psychological and spiritual affiliation,4 if the safety and efficacy of phytomedicine are proven with credible evidence-based clinical data to be comparable or superior to conventional drugs.5 The current study used the C. speciosus rhizome that is classified under the genus of Costus Linn, which belongs to the Costaceae family and the Zingiberales order. Turshar et al6 conducted a survey of the use of Zingiberaceous plants and found that the rhizomes were the primary plant material used as a source of medication. They also indicated that C. speciosus and Zinggiber purpureum are 2 of the important species for future work. In traditional medicine, C. speciosus has many uses in medical treatment as in fever, asthma, tonsillitis, bronchitis, skin disease, constipation, and snake and insect bites.6 In Prophetic medicine, the use of C. speciosus was specifically recommended for the treatment of inflammation of the pharynx/tonsils in children, pleurisy, and as a snake venom antidote.7 As documented by Anas Ibn Malek: “Cupping (Hijama) and Qust al-Bahri (Sea Incense Costus) are the best of your remedies, and don’t harm your children by treating tonsillitis by pressing their tonsils” [Saheeh Muslim 1577]. Currently in the literature, numerous studies have reported various bioactivities of C. speciosus to support its medical use as anti-fungal, anti-microbial, and anti-inflammatory. Duraipandiyan et al8 conducted an in vitro study of C. speciosus in which it was found that it exhibited a moderate activity against Staphylococcus aureus, Staphylococcus epidermis, and Bacilus subtilis, and it had a significant anti-fungal effect in hexane extract, which has the active compound of costunolide and eremanthin. Srivastava et al9 confirmed that a methanol extract of C. speciosus has significant anti-inflammatory, analgesic, and antipyretic activities in an animal study at a dose of 400 and 800 mg/kg. Therefore, we conducted the current pilot study to determine the objective and subjective effects, tolerability, and safety of the alternative treatment of aqueous Costus speciosus (C. speciosus) rhizome in pediatric and adult patients suffering from acute pharyngitis and tonsillitis. Disclosure. Authors have no conflict of interests, and the work was not supported or funded by any drug company.