Year : 2020 | Volume
: 14 | Issue : 2 | Page : 110--121
Homoeopathy in the management of infectious diseases: Different facets of its use and implications for the future
Roja Varanasi, Debadatta Nayak
Central Council for Research in Homoeopathy, New Delhi, India
Dr. Roja Varanasi
Central Council for Research in Homoeopathy, New Delhi
Background: Infectious diseases are a major challenge to humanity and public health at large. Objective: The aim of this study is to conduct a systematic narrative review of the clinical research evidence for homeopathy in the management of infectious diseases. Methods: A comprehensive search of major biomedical databases: Cochrane Database of Systematic Reviews, Pubmed, Core-Hom, AYUSH Research Portal) and other individual journal sites were conducted. Relevant research published between 1999 and 2019 was categorised by study type, clinical condition and causative pathogen. Results: The literature search of two decades (1999–2019) gathered 86 articles: Meta-analysis (n = 1), systematic reviews (n = 4), randomised controlled trials (n = 30), comparative cohort/observational studies (n = 16), cohort/observational studies (single arm) (n = 25), case series (n = 7) and case reports (n = 3). The review demonstrated the beneficial evidence of homeopathy in infectious diseases is large. Both controlled and uncontrolled studies reported positive results, early recovery, reduction of hospital stay, less use of antibiotics and satisfaction of patients. Prophylactic studies on dengue, chikungunya, Japanese encephalitis/acute encephalitis syndrome and leptospirosis have shown the potential role of homeopathy in preventing the disease outbreaks. Homoeopathy as an add-on treatment for these conditions has shown added benefits in reducing mortality, morbidity and sequelae. Homoeopathy has a possible and viable role as standalone and as an integrative medicine for different infectious diseases. Conclusion: Homoeopathy offers beneficial role in combating infections. Due to the heterogeneity of approaches, more studies in different research settings are warranted to add to the existing evidence and validating it for enhancing the self-healing power of the body against infections.
|How to cite this article:|
Varanasi R, Nayak D. Homoeopathy in the management of infectious diseases: Different facets of its use and implications for the future.Indian J Res Homoeopathy 2020;14:110-121
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Varanasi R, Nayak D. Homoeopathy in the management of infectious diseases: Different facets of its use and implications for the future. Indian J Res Homoeopathy [serial online] 2020 [cited 2021 Jan 18 ];14:110-121
Available from: https://www.ijrh.org/text.asp?2020/14/2/110/285291
Zoonotic diseases are very common around the world. It is estimated that 6 out of every 10 known infectious diseases can spread from animals, and 3 out of every 4 new or emerging infectious diseases in people come from animals. The world has witnessed several outbreaks of infectious diseases such as Cholera, Plague, Spanish flu, Swine flu. Globalization, international travel and intercontinental commerce have all increased the potential for microbial spread, resulting in pandemics beyond their respective regions of origin such as Severe Acute Respiratory Syndrome, Middle East Respiratory Syndrome coronavirus, Zika, Ebola and now recently the outbreak of COVID-19 from Wuhan, China, in December 2019.
These diseases pose a major threat to public-health across the world. Although some infectious diseases, such as small pox and poliomyelitis, have been eradicated from nature or almost wiped out, many diseases still persist with little hope of getting them under control. In addition, new infectious diseases are emerging and old ones that were thought to be under control are regaining lost ground. Apart from affecting the health of individuals directly, infectious diseases also impact the societies, economies and political systems.
Anti-virals, vaccines, and antibiotics are the standard treatments offered by conventional system for infectious diseases. However, their control is particularly challenging as the pathogens, the host, the context and the health systems (all of which interact with each other) change simultaneously. Further, during sudden outbreaks, emergence of new or resistant strains, for which there is little immune protection in the hosts, enables the disease to spread very rapidly. A growing number of infections– such as pneumonia, tuberculosis (TB), gonorrhoea and salmonellosis – are becoming harder to treat as the antibiotics used to treat them have become less effective. Antibiotic resistance leads to longer hospital stays, higher medical costs and increased mortality.
Keeping in mind the above issues, experts from the World Health Organisation in their statement for containment of Ebola virus disease recommended, 'In the particular circumstances of this outbreak, and provided certain conditions are met, the panel reached consensus that it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention'.
Homoeopathy, a holistic system of medicine, has been in use for infectious diseases dating back to the time of its inventor Hahnemann, who recommended Belladonna for scarlet fever. The curative effect of individualised homeopathic medicines is empirical but inexplicable by the conventional principles of science. Homoeopathy may be viewed as 'personalised nanomedicine'. They produce modulation of immune function at multiple levels, such as modulation of expression of genes, stimulation of macrophage and polymorph nuclear cells, changes in expression of surface receptors, induction of cytokines and modulate the central and local innate immune response leading to adaptive changes in the host's complex networks.,,
Homoeopathy is used for infectious diseases in different ways. While individualised treatment is the gold standard, it is impractical to use on a widespread basis during epidemics. Combination remedies can be effective, but they must be selected based on the symptoms of a given epidemic in a specific location. Treatment with genus epidemicus can also be successful, if based on data from many practitioners. Finally, isopathy shows promise and might be more readily accepted by mainstream medicine due to its similarity to vaccination. Further homoeopathy is also safe and effective when used as an add-on to standard care. Being used across the globe, and in Indian sub-continent, as a treatment for infectious conditions, it is valuable to review the evidence for Homoeopathy in infectious diseases
A comprehensive search for the articles published during the period 1999–2019 in different journals on Homoeopathy and infectious diseases (Clinical) was carried out. Databases search was done in two phases: Phase I included: Cochrane Database of Systematic Reviews, PubMed (US National Library of Medicine). In phase two, additional search was performed through 'Google Scholar', 'CORE-Hom database', 'AYUSH Research Portal' and other individual journal sites.
The key search terms used were: '(Homeopathy) AND infections', '(homeopathy) AND infections) AND clinical trials', '(Homeopathy) AND infections) AND clinical research', '(homeopathy) AND infectious diseases) AND cohort studies', (Homeopathy AND infectious diseases) AND case series), '(homeopathy) AND infectious diseases) AND case report'. Emphasis was given on papers with the English language only. However, a few papers with other language but abstract in English were included. Veterinary research and laboratory-based basic research were not included.
All the literature, irrespective of the study design, hypothesis generating studies (case reports, case series, observational/cohort studies) and hypothesis testing ones (randomised controlled trials [RCTs], meta-analysis) were considered in this paper.
Potential research articles were noted for retrieval and given a preliminary 'study type' categorisation. The basic categories included systematic reviews, meta-analysis, randomised controlled trials (RCT), comparative cohort studies (CC), cohort (observational) with single arm studies, case series, case reports. Further the studies were categorised according to causative infectious agents such as viral, bacterial, mite and parasite. All evidences were included, if the effect on the clinical condition related to infectious disease, it was noted with a clearly defined outcome.
Data were extracted systematically using a specifically designed form in excel spreadsheet. Data extracted included author, clinical condition, causative factor, study design, number of participants, type of intervention in homoeopathy (individualised or complex or isopathy/nosode) and any comparator or control arm, adjuvant/standalone homoeopathy, outcome measures and results.
The literature search of two decades' (1999–2019) publications gathered 86 articles: Meta-analysis (n = 1), systematic review (n = 4), RCTs (n = 30), CC/observational studies (n = 16), cohort/observational studies (single arm) (n = 25), case series (n = 7) and case reports (n = 3).
As per the causative infectious agent, the break up is as follows: Viral (n = 52), bacterial (n = 12), viral/bacterial (n = 18), mites (n = 1), fungal (n = 1) and parasitic (n = 1). 3,058,730 patients/healthy population participated in these studies.
The search identified the following clinical conditions: Upper respiratory tract infections (URTI) (n = 26), influenza like illness (ILI) (n = 7), Dengue (n = 6), Sinusitis (n = 6), Acute diarrhoea (n = 5), acute otitis (n = 5), human immunodeficiency virus (HIV) (n = 4), TB (n = 4), urinary tract infection (UTI) (n = 3), Acute Encephalitis syndrome (AES)/Japanese Encephalitis (JE) (n = 3), Chikungunya (n = 2), Tonsillitis (n = 3), dysentery (n = 1), Furunculosis (n = 1), gastroenteritis (n = 1), Hepatitis C (n = 1), High Risk Human Papillomavirus (n = 1), Leptospirosis (n = 1), Acute tracheobronchitis (n = 1), Molluscum contagiosum (n = 1), periodontitis (n = 1), Scabies (n = 1), sepsis (n = 1) and vulvovaginitis (n = 1).
Homoeopathic medicines in the above clinical conditions were used either as standalone or as add-on to standard or usual care. There were 61 studies wherein homoeopathy was prescribed as standalone, and 19 where it was administered as adjuvant to standard care or usual care. 03 were systematic reviews and 03 other were comparative cohort studies. Homoeopathy was administered as combination remedies or complex homeopathy (homoeopathic formulations) in 25 studies, individualised homeopathy (IH) in 52 studies and as nosode (isopathy) in 6 studies.
Summary of studies
Acute diarrhoea is a common problem for children under 5 years of age and a potential cause for death. Five studies were identified: One meta-analysis and three RCT, by Jacobs et al. (n = 2), and Patel et al., respectively, and one cohort study by Nayak et al. Meta-analysis showed a reduced duration of diarrhoea in the homeopathy group compared to placebo group. The meta-analysis shows a consistent effect-size difference of approximately 0.66 days. Similarly, the studies done in Indian set up at tribal area and urban set up also gave similar results. However, using complex homoeopathy for acute childhood diarrhoea by Jacobs et al. showed no significant difference in the likelihood of resolution of diarrheal symptoms between the treatment and placebo groups.
Acute otitis, a common paediatric problem with inappropriate antibiotic prescribing, contributes to the burden of antibiotic resistance. Homeopathic medicines offer pragmatic treatment alternatives to conventional drugs for symptom relief in children with uncomplicated AOM or URIs. Five RCTs were identified, Jacob et al. used IH and concluded significant decrease in symptoms at 24 and 64 h after treatment in favor of homeopathy through diary scores, Taylor and Jacobs, used homoeopathic ear drops (Containing Pulsatilla, Chamomilla, Sulphur, Calcarea carbonica, Belladonna, and Lycopodium) externally as adjuvant to standard care with successful outcomes. Pedrero-Escalas et al. used complex homoeopathy (Agraphis nutans 5CH, Thuja occidentalis 5CH, Kalium muriaticum 9CH and Arsenicum iodatum (9CH) along with aerosol therapy with no significant results. Sinha et al. in their RCT used IH in LM potency against conventional treatment (CT). Both the groups were prescribed symptomatic treatment. 97.5% in the conventional group required antibiotics and none in the Homeopathy group.
Respiratory tract infections
The majority of URTI is caused by rhinoviruses and antibiotics may provide only modest absolute benefits. 23 studies were identified: 04 systematic reviews, 8 RCTs, 10 CC, 3 single cohort studies, and one case series.
Bellavite et al. in their systematic review concluded that homeopathic formulations in upper respiratory tract and otorhinolaryngological infections are likely effective and the individualised approach in non-severe otitis is possibly effective. Homeopathic treatments may help when use of antibiotics is not indicated. Hawke et al. in their systematic review on homoeopathic medicinal products concluded no evidence to support the efficacy of homeopathic medicinal products for ARTIs in children. In the light of antimicrobial resistance (AMR), Fixsen in his review suggests homeopathy offers alternative strategies for minor infections and possible prevention of recurring URTIs.
05 RCTs used complex homeopathy (homoeopathic formulations) with positive findings in all the studies. Jacobs and Taylor using homeopathic cold syrup showed significant improvement in sneezing, cough in intervention arm to placebo recipients. van Haselen et al. in their homeopathic add-on therapy (Influcid; IFC-group) for 7 days in a pediatric subpopulation with URTI reflected usage of less symptomatic medication, and significantly earlier resolving of symptoms in the add-on treatment group and was safe to use. Lyrio et al. tested biotherapics ARI (Acute Respiratory Infection) and InfluBio on children showing positive effects of both the biotherapics than placebo, and minimised the frequency of symptomatic episodes of flu. Jong et al. investigated CalSuli-4-02 tablets on prevention of recurrent acute URTIs in children, in comparison to another complex homeopathic product with reduction in the median number of acute URTIs over 3 months. Antibiotic use was decreased with overall satisfaction and higher tolerability with CalSuli-4-02. Zanasi et al., in their studies compared homeopathic syrup against placebo for treating cough due to URTI in adults and inferred that the homeopathic syrup was able to effectively reduce cough severity and sputum viscosity representing a valid remedy for acute cough due to URTIs. Conde Diez et al. studied the effect of complex homeopathy as an add-on to CT for prevention URTI in COPD patients and suggested beneficial impact at reducing number of URTIs' and duration in COPD patients and also reducing the number of COPD exacerbations.
Three studies by Steinsbekk et al.,, showed different results with IH. The self treatment with one of the three self-selected, ultramolecular homeopathic medicines for the prevention of URTIs in children showed no effect over placebo. An exploratory study (RCT) of the contextual effect of homeopathic care (HC) versus self-prescribed homeopathic medicine (SPH) in the prevention of URTI in children also showed no significant differences in clinical effects between SPH and HC showed trend in favour of HC. Whereas an open, pragmatic, randomised parallel-group trial with waiting-list group as control showed a clinically relevant effect of IH care in the prevention of URTI in children.
Eleven CC studies were identified. Out of these, one CC was a retrospective data comparing homeopathic medicine (specific extract of duck liver and heart) and not treated group. These results suggest that homeopathic medicine may have a positive effect in preventing Respiratory tract infections (RTIs). The reduction in the mean number of RTI episodes during the period of observation versus the year before inclusion in the study was significantly greater in the homeopathic-treated group than in untreated patients. Out of the 09 prospective CC studies, 04 studies used complex homeopathy such as homeopathic syrup, Engystol, viburcol, Gripp-Heel and Euphorbium compositum. These studies have shown positive outcomes in their identified objectives in terms of establishing non-inferiority, reduction of symptoms.
Three CC studies were very pragmatic, and compared IH to Conventional Treatment (CT). Grimaldi-Bensouda et al. in their study involved general physicians (GPs) who practiced CT alone versus GPs who practiced both conventional and homeopathy. Patients who chose to consult GPs certified in homeopathy used less antibiotics and antipyretic/anti-inflammatory drugs for URTI. Haidvogl et al. in his study showed the in primary care, homeopathic treatment for acute respiratory and ear complaints was not inferior to CT. While Riley et al. in his study also concluded that in primary care, homeopathic treatment for acute respiratory and ear complaints was not inferior to CT. A pharmacoeconomic study by Trichard et al. concluded homeopathy as cost-effective alternative to antibiotics in the treatment of recurrent infantile rhinopharyngitis.
Three single cohort studies were identified. Nayak et al. in their study on acute rhinitis in children when prescribed pre-defined medicines based on individualisation, had significant reduction in the acute rhinitis symptom score with no significant adverse events. Michalsen et al. assessed safety of complex homeopathic drug (Contramutan N Saft). The physicians detected 60 adverse events from 46 patients (4.4%). Adverse drug reactions occurred in 14 patients (1.3%). Six patients showed proving symptoms (0.57%) and only one homeopathic aggravation (0.1%) appeared. All observed events recovered quickly and were of mild-to-moderate intensity. Another study on acute respiratory tract infections also showed improvement in symptoms. Ramchandani reported a series of 30 cases managed homoeopathically.
Influenza like illnesses
During the past century, world has faced four pandemic outbreaks of influenza which is enough to say the kind of threat the condition poses to the mankind. The review on ILI identified 07 studies; 01 systematic reviews, 02 RCT, 01CC, and 03 single cohort studies. A systematic review by Mathie et al. on Oscillococcinum®) (a patented homeopathic medicine that is made from a 1% solution of wild duck heart and liver extract, which is then serially diluted 200 times with water and alcohol) concluded that paucity of good evidence, robust conclusions cannot be drawn in the prevention or treatment of influenza and ILI. One RCT published by Chakraborty et al. investigated the effect of IH in the treatment of ILI in centesimal (CH) and 50 millesimal (LM) potencies against placebo through a multicenter, prospective, randomised, triple arm placebo controlled trial. There was a significant difference in temperature, headache, myalgia, Malaise, sore throat, fatigue, nasal complaints, cough and chill improved in both the treatment groups (CH and LM groups) compared to placebo within 3 days of treatment. Siqueira et al. investigated homoeopathic complex, Influbio® and placebo on patients suffering from influenza and acute respiratory tract infections in children through a pragmatic clinical trial. These results suggested that the use of homeopathic medicines minimised the number of flu and symptomatic episodes of acute respiratory infection in children, thus signalling the potential of homeopathic medicine (complex) as a prophylactic.
During the swine flu (SF) pandemic in 2009, three single cohort studies and 01 CC, two studies were undertaken. Mathie et al. in their data collection study of 1126 Indian patients during pandemic reported 89 different combinations of SF symptoms. The most common (15%) being temperature >38 degrees C + cough + runny nose. Forty-four different remedies (or combinations of remedies) were used and the most frequently prescribed being Arsenicum album (23.5%). Frei analysed the data of the prescription based on polarity analysis on 52 patients with ILI followed over 4 weeks resulted in 62% cure by the first remedy within 2 days of treatment. 21 different remedies cured influenza. Cocculus, Natrium muriaticum, Phosphorus, Bryonia, Nux vomica, and Arsenicum album were used in half of all the patients. Another study by Vincent wherein patients were treated for ILI by their GPs inferred patient satisfaction with treatment by the 4th day of treatment.
CC study by Danno et al. investigated effectiveness of homoeopathy in two groups of patients through 242 pharmacists, who prescribed over the counter medicines. The two groups of patients (those recommended allopathic medicine only, and those recommended homeopathic medicine with or without allopathic medicine) had comparable clinical outcomes. Patients who were recommended homeopathic medicine by pharmacists were younger, and had more severe symptoms than those recommended allopathic medicine. This study also highlighted the important role played by the pharmacists in the effective management of ILI and ENT disorders.
Acute encephalitis syndrome/Japanese encephalitis
AES/(JE) is a major health burden in India with 30% mortality and morbidity. Gadugu et al. in their prophylactic study at Andhra Pradesh administered Belladonna 200 on 1, 2, 3 days one dose each, Calcarea Carbonica 200 on 10th day and Tuberculinum 10 M on the 25th day, in a phased manner on time series, to all children in the age group of 0–15 years in the month of August every year for three consecutive years. The intervention resulted in drastic drop of the mortality and morbidity rates. 01 RCT by Oberai et al. and 01 CC by Manchanda et al. conducted in a tertiary care hospital of Uttar Pradesh, investigated effect of homoeopathic medicine as an add-on to standard care in children suffering from AES compared to standard care. Modified Glasgow coma scale assessed the severity and Glasgow outcome scale assessed the primary outcomes in terms of death, neurovegetative sate, moderate disability and severe disability and recovery. Morbidity was assessed using the Liverpool Outcome Score for assessing children at follow-up. These studies showed reduction of mortality rates from 15% to 30%, with 84% having less morbidity and sequelae.
During the year 2007, India witnessed an epidemic of chikungunya. Nair et al., during the epidemic, conducted a double blind RCT was conducted, wherein following the method of Hahnemann, Bryonia alba 30 CH, was prescribed as genus epidemicus to prevent Chikungunya. Investigators first repertorised the symptoms of 205 patients with fever and arthralgia, characteristic of Chikungunya. A group of homeopathic experts then came to a consensus for Bryonia as the genus epidemicus after confirming symptoms in the Materia Medica. Family groups of approximately 200 individuals, known as 'clusters', were then randomized to take either Bryonia 30CH or placebo during the time of the active epidemic. Out of nearly 20,000 healthy individuals in each group, 12.8% of those receiving Bryonia developed the illness compared with 15.8% of those taking the placebo (P = 0.03). This translates into a relative risk reduction of nearly 20% in contracting chikungunya. A treatment study on chikungunya and post-chikungunya chronic arthritis (PCCA) by Wadhwani showed complete recovery in 84.5% CF cases, in a mean time of 6.8 days. 90% cases of PCCA recovered completely in a mean time of 32.5 days.
Dengue, a mosquito-borne viral infection has no specific treatment or vaccine available for it. Review identified 01 RCT, 02 CC, 01 cohort study (single arm) and 01 case series.
Nayak et al. conducted a comparative study in thrombocytopenia due to dengue at a tertiary care Hospital in Delhi, India. 138 patients received a homeopathic medicine along with usual care (H + UC) and 145 patients received usual care (UC) alone. There was a statistically significant rise in platelet count on day 1 of follow-up in the H + UC group, compared with UC alone. This trend persisted until day 5. These results suggest a positive role of adjuvant homeopathy in thrombocytopenia due to dengue.
Hassan recently reported the results of a trial of a homeopathic combination remedy for dengue fever in Pakistan. The homeopathic combination appeared to be a more potent treatment against dengue fever. Jacobs et al. in their study used homoeopathic combination of six remedies comparing with placebo in patients with symptoms of dengue fever in Honduras. They found no differences in the resolution of pain and fever or the use of analgesics between the two groups. Nunes et al. from Brazil conducted a time series study with homoeopathic combination and compared the incidence in different years. The incidence of the disease in the first 3 months of 2008 fell 93% by comparison to the corresponding period in 2007, whereas in the rest of the State of Rio de Janeiro there was an increase of 128%.
Mahesh et al. and Rath et al., in their case series of dengue (n = 14), showed the potential of homoeopathic medicines in managing the disease.
Shah developed the hepatitis C virus (HCV) nosode and conducted an open-label observational study in 24 HCV-positive individuals using 30C and 50C potencies of the nosode. From week 12 to week 24, the mean viral load decreased. Most participants in this study showed improvement in appetite and weight gain.
Human immunodeficiency virus
Four studies were identified, 01 RCT, and 03 single cohort studies. Rastogi et al., in their first of its kind novel study, enrolled 100 patients and aimed to evaluate the immuno-modulator role of homeopathic remedies in (HIV) infection (Asymptomatic HIV infection, and Persistent Generalised Lymphadenopathy (PGL) by comparing the effect of with placebo. In PGL, analysis of change in the pre- and post-trial counts of CD4(+ve) cells between groups was statistically significant (P = 0.04). The study suggested a possible role of homeopathic treatment in HIV infection.
Mishra et al., in their large cohort of 870 HIV patients, evaluated the role of homoeopathic medicines in delaying the progression of infection. 61% patients maintained asymptomatic status for a period varying from 3 to 10 years. The intercurrent ailments such as oral candidiasis, oral ulcers, loss of appetite, generalized pruritic dermatitis etc., also responded favorably.
Muraleedharan et al., using individualised homoeopathic medicines, studied the changes in CD4 and viral load volumes in 72 patients, completing the follow up period of 6 months. There was significant change in viral load. Other parameters like Body Mass Index, Quality of life also improved.
Shah developed a new HIV nosode and evaluated its effect on 27 HIV positive individuals using 30 C and 50 C potencies as an autonosode. 07 patients showed a sustained reduction in the viral load from 12 to 24 weeks. Similarly, 09 participants (33.33%) showed an increase in the CD4+ count by 20% altogether in 12th and 24th week along with gain in weight.
TB is one of the top 10 causes of death and the leading cause from a single infectious agent and Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. Four studies were identified: 01 RCT on MDR-TB, 01 case series on tubercular lymphadenitis, 02 case reports on TB with other diseases such as Pots spine. Chand et al., in their double-blind RCT, investigated 120 diagnosed MDR-TB patients (both culture positive and negative) with Standard Regimen + individualised homeopathic medicine (SR + H) or Standard Regimen + identical placebo (SR + P). Radiological findings of chest showed significant improvement in homoeopathy added group. Further there was also weight gain, increase in haemoglobin and reduction in ESR with add-on homeopathy.
Chand et al. successfully treated cases of Pott's spine with paravertebral abscess, not responding to anti tubercular treatment (ATT), Recurrent sub-acute intestinal obstruction, Pulmonary TB with adjuvant homeopathy, with improvement in general well-being. Goyal reported two cases of pulmonary TB treated with homeopathy.
Tubercular lymphadenitis (TBLN) was also successfully treated by Chand et al. using homeopathic medicine along with ATT on 25 patients and developed a homeopathic regime consisting of a patient specific constitutional medicine, one disease specific biotherapy (Tuberculinum) and Silicea 6X as supportive medicine sending a message for use of homoeopathy as a complement to ATT and large effectiveness studies.
Leptosirosis is caused by a gram-negative bacterium, cause serious infections such as meningitis, hepatitis, and pneumonitis. Bracho et al. in Cuba during an epidemic of leptospirosis from 2007 to 2008, developed a nosode (NosoLep) from four strains of inactivated Leptospira. Ninety-seven percent of the entire population over 1 year of age was treated with the nosode. Over a 5-week period, more than 2 million people received two oral doses of the 200C potency of this preparation. This was followed nearly a year later with two 10M doses of the same nosode. Disease surveillance statistics revealed an 84% decreased incidence of the disease in these provinces in 2008 compared with previous years, despite the occurrence of three large hurricanes.
Other conditions for which positive role of homeopathy was found were gastroenteritis, furunculosis, acute tracheobronchitis, recurrent UTI in women, chronic sinusitis,,,,,, UTI due to neurogenic bladder dysfunction, high risk human papilloma virus, dysentery, tonsillitis,,, molluscum contagiosum, scabies, periodontitis, sepsis, vulvovaginitis.
The overview of the published literature in the field of question shows that there are several positive studies tending to support a clinically demonstrable activity of homeopathic medicines in the management of infectious diseases. The review included all types of reports from systematic reviews/meta-analysis to case reports in the hierarchy of evidence. The broad scope of the review has enabled the inclusion of case reports, being used in practice and currently have no supporting empirical evidence, paving the way for more targeted research into clinical effectiveness.
The conclusions from reviews papers demonstrated a large heterogeneity of the published clinical trials. The number of randomized studies in various fields is small, and proofs of efficacy/effectiveness considering single drugs or single clinical approaches. This is in concurrence with results of Mathie et al. A systematic review of RCTs of non-individualized homeopathic treatment (NIHT) preclude a decisive conclusion about the comparative effectiveness of NIHT. Nevertheless, complex homoeopathy remains compatible for research even when modern approach draws scepticism for not following homeopathic principles of prescribing. Papers published in peer-reviewed journals though increasing, are characterised by low standards of methodology.,
The highest number of studies were from URTIs. Homeopathic medicines compared to CT have shown reduction in antibiotics, are cost effective and reduce recurrences and duration of illness.,,, The medicines are compatible to all age groups, and are well tolerated.
AMR threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi. The clinical trials examined in this article showed variations in size, location, cohort types, type of intervention and outcome measures, which make comparisons and generalisations problematic. Combined evidence suggests that homeopathic treatment can exert biological effects with fewer adverse events and broader therapeutic opportunities than conventional medicine in the treatment of URTIs.
Homoeopathy as a holistic system medicine which takes care of person as a whole, and prescribed based on symptom totality can be used before the disease diagnosis. Because of its minimum dose and simple medicines, extends its scope in integrative medicine. Studies show strength of this system in managing multimorbidity too., Add-on or adjunctive treatment is another option wherein homoeopathy has viable and potential role to play in integrative patient care. The rationale for adjunctive treatment is usually one of the following: (a) another or other treatment have been only partially effective on core symptoms. (b) Another or other treatments have been effective on core target symptoms, but for some other concurrent symptoms, a further medicine is believed to be required. (c) A particular combination might be beneficial de novo in some indications. (d) The combination could improve tolerability because two compounds may be employed below their individual dose thresholds for side effects.
Homeopathy as an adjunctive treatment can reduce mortality and morbidity, duration of hospital stay (AES, dengue), and can increases compliance to CT in diseases (TB), and thus provide long-term benefit.,,,
The limitation of this study is the lack of a detailed quality analysis of each included study because our object was essentially descriptive and not to draw quantitative conclusions, or clinical recommendations. Heterogeneity of different levels of studies further prevents drawing strong conclusions.
Implications for the future
Homeopathy appears to have a number of potential advantages in infectious diseases:
It has high acceptability, as high proportion of patients suffering from infectious diseases, spontaneously seek homeopathic treatmentIt is relatively safe and cost-effective. The low cost of the medicines may, however, be offset by longer or more frequent consultations and costs may vary between countries and systems of reimbursementHomoeopathic medicines can be manufactured easily in large scale and easy distribution make it a viable option during epidemics/pandemicsIt is safe and effective when used as an adjuvant or add-on to conventional treatment. There is a possible role of integration of homeopathy with the standard care for the treatment of all types of infectious diseases including those with high mortality and morbidity. It may lead to reduction in hospital stay, cost of care, loss of work-days, increased compliance to conventional treatment, thus may reduce health-care burden on hospitals, government policiesHomeopathic treatment may help when use of antibiotics is not indicated and anti-virals/antibiotics are not yet tested for new emerging diseasesDue to the heterogeneity of approaches, and of drugs used, more studies will be required to add to the existing evidence in different clinical conditions.
The review demonstrated the beneficial evidence of homeopathy in different infectious diseases is large. Due to the heterogeneity of approaches, more research to build evidence in different research settings are warranted.
The authors acknowledge Anil Khurana, Director General, Central Council for Research in Homoeopathy for valuable suggestions in the draft manuscript and Ms. Meenakshi Bhatia, Jr., Librarian for her help in providing few publications.
Financial support and sponsorship
Conflicts of interest
|1||CDC. Zoonotic Disease One Health CDC; 2019. Available from: https://www.cdc.gov/onehealth/bas ics/zoonotic-diseases.html. [Last accessed on 2020 May 08].|
|2||Snowden FM. Epidemics and Society-From the Black Death to the Present. 1st ed. London: Yale University Press; 2019. p. 600.|
|3||WHO. Coronavirus disease (COVID-19) outbreak WHO [Internet] 2019. Available from: https://www.who.int/westernpacific/emergencies/covid-19. [Last cited on 2020 Apr 23].|
|4||Coker R, Rifat Atun MM, editors. Health Systems and the Challenge of Communicable Diseases. Experiences from Europe and Lain America. MC Graw Hill. UK: Open University Press; 2008.|
|5||World Health Organization. Antibiotic Resistance: WHO Factsheet. World Health Organization; 2018.|
|6||World Health Organization. Ethical Considerations for use of Unregistered Interventions for Ebola Virus Disease (EVD). World Health Organization; 2016.|
|7||Hufeland CW. On the prophylactic powers of Belladonna against scarlet fever. Lancet 1829;12:135.|
|8||Rajendran ES. Homeopathy seen as personalised nanomedicine. Homeopathy 2019;108:66-70.|
|9||Gupta VK, Mathur M. Immunomodulatory effects of homeoapthic medicines: A review of pre-clinical studies. Indian J Res 2018;12:90-4.|
|10||Bonamin LV, Sato C, Zalla Neto R, Morante G, Cardoso TN, de Santana FR, et al. Immunomodulation of Homeopathic Thymulin 5CH in a BCG-Induced Granuloma Model. Ren K, editor. [Journal on the Internet]. Evidence-Based Complement Altern Med 2013. [cited May 08]. doi: 10.1155/2013/686018|
|11||Bell IR, Schwartz GE, Boyer NN, Koithan M, Brooks AJ. Advances in integrative nanomedicine for improving infectious disease treatment in public health. Eur J Integr Med 2013;5:126-40. doi:10.1016/j.eujim.2012.11.002.|
|12||Jacobs J. Homeopathic prevention and management of epidemic diseases. Homeopathy 2018;107:157-60.|
|13||Kaur H, Chalia DS, Manchanda RK. Homeopathy in public health in India. Homeopathy 2019;108:76-87.|
|14||World Health Organization. Diarrhoeal Disease. Available from: https://www.who.int/en/news-room/fa ct-sheets/detail/diarrhoeal-disease. [Last accessed on 2020 May 08].|
|15||Jacobs J, Jonas WB, Jiménez-Pérez M, Crothers D. Homeopathy for childhood diarrhea: Combined results and metaanalysis from three randomized, controlled clinical trials. Pediatr Infect Dis J 2003;22:229-34.|
|16||Jacobs J, Jiménez LM, Malthouse S, Chapman E, Crothers D, Masuk M, et al. Homeopathic treatment of acute childhood diarrhea: Results from a clinical trial in Nepal. J Altern Complement Med 2000;6:131-9.|
|17||Jacobs J, Guthrie BL, Montes GA, Jacobs LE, Mickey-Colman N, Wilson AR, et al. Homeopathic combination remedy in the treatment of acute childhood diarrhea in Honduras. J Altern Complement Med 2006;12:723-32.|
|18||Patel M, Pawaskar N, Mundra P, Tamboli P, Kothare G. An approach to acute diarrhoeal disorders through sector and constitutional homoeopathic treatment in tribal children attending Balwadis. Indian J Res Homeopath 2010;4:36-48.|
|19||Nayak C, Singh V, Singh K, Singh H, Ali S. A prospective multicentric observational study to evolve the usefulness of the predefined homoeopathic medicines in the management of acute diarrheal disease in children. Indian J Res Homoeopath 2009;3:21-8.|
|20||Bell IR, Boyer NN. Homeopathic medications as clinical alternatives for symptomatic care of acute otitis media and upper respiratory infections in children. Glob Adv Heal Med 2013;2:32-43.|
|21||Jacobs J, Springer DA, Crothers D. Homeopathic treatment of acute otitis media in children: A preliminary randomized placebo-controlled trial. Pediatr Infect Dis J 2001;20:177-83.|
|22||Taylor JA, Jacobs J. Homeopathic ear drops as an adjunct to standard therapy in children with acute otitis media. Homeopathy 2011;100:109-15.|
|23||Taylor JA, Jacobs J. Homeopathic ear drops as an adjunct in reducing antibiotic usage in children with acute otitis media. Glob Pediatr Heal 2014;1:2333794X1455939. DOI: 10.1177/2333794X14559395.|
|24||Pedrero-Escalas MF, Jimenez-Antolin J, Lassaletta L, Diaz-Saez G, Gavilan J. Hospital clinical trial: Homeopathy (Agraphis nutans 5CH, Thuya occidentalis 5CH, Kalium muriaticum 9CH and Arsenicum iodatum 9CH) as adjuvant, in children with otitis media with effusion. Int J Pediatr Otorhinolaryngol 2016;88:217-23.|
|25||Sinha MN, Siddiqui VA, Nayak C, Singh V, Dixit R, Dewan D, et al. Randomized controlled pilot study to compare Homeopathy and Conventional therapy in Acute Otitis Media. Homeopathy 2012;101:5-12.|
|26||Simoes EAF, Cherian T, Chow J, Shahid-Salles SA, Laxminarayan R, John TJ. Acute Respiratory Infections in Children. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): World Bank; 2006. Chapter 25. PubMed PMID: 21250360.|
|27||Bellavite P, Marzotto M, Andreoli B. Homeopathic treatments of upper respiratory and otorhinolaryngologic infections: A review of randomized and observational studies. J Altern Complement Integr Med 2019;5:1-4.|
|28||Hawke K, van Driel ML, Buffington BJ, McGuire TM, King D. Homeopathic medicinal products for preventing and treating acute respiratory tract infections in children. Cochrane Database Syst Rev 2018;4:CD005974. doi: 10.1002/14651858.CD005974.pub4.|
|29||Fixsen A. Homeopathy in the age of antimicrobial resistance: Is it a viable treatment for upper respiratory tract infections? Homeopathy 2018;107:99-114.|
|30||Jacobs J, Taylor JA. A randomized controlled trial of a homeopathic syrup in the treatment of cold symptoms in young children. Complement Ther Med 2016;29:229-34.|
|31||van Haselen R, Thinesse-Mallwitz M, Maidannyk V, Buskin SL, Weber S, Keller T, et al. The effectiveness and safety of a homeopathic medicinal product in pediatric upper respiratory tract infections with fever: A randomized controlled trial. Glob Pediatr Health 2016;3:2333794X16654851. doi: 10.1177/2333794X16654851.|
|32||Lyrio C, Siqueira CM, Veiga VF, Homsani F, Marques AL, Biolchini J, et al. The use of homeopathy to prevent symptoms of human flu and acute respiratory infections: A double-blind, randomized, placebo-controlled clinical trial with 600 children from Brazilian public health service. Int J High Dilution Res 2011;10:174-6.|
|33||Jong MC, Buskin SL, Ilyenko L, Kholodova I, Burkart J, Weber S, et al. Effectiveness, safety and tolerability of a complex homeopathic medicinal product in the prevention of recurrent acute upper respiratory tract infections in children: A multicenter, open, comparative, randomized, controlled clinical trial. Multidiscip Respir Med 2016;11:19.|
|34||Zanasi A, Mazzolini M, Tursi F, Morselli-Labate AM, Paccapelo A, Lecchi M. Homeopathic medicine for acute cough in upper respiratory tract infections and acute bronchitis: A randomized, double-blind, placebo-controlled trial. Pulm Pharmacol Ther 2014;27:102-8.|
|35||Zanasi A, Cazzato S, Mazzolini M, Ierna CM, Mastroroberto M, Nardi E, et al. Does additional antimicrobial treatment have a better effect on URTI cough resolution than homeopathic symptomatic therapy alone? A real-life preliminary observational study in a pediatric population. Multidiscip Respir Med 2015;10:25.|
|36||Conde Diez S, Viejo Casas A, Garcia Rivero JL, Lopez Caro JC, Ortiz Portal F, Diaz Saez G. Impact of a homeopathic medication on upper respiratory tract infections in COPD patients: Results of an observational, prospective study (EPOXILO). Respir Med 2019;146:96-105.|
|37||Steinsbekk A, Bentzen N, Fønnebø V, Lewith G. Self treatment with one of three self selected, ultramolecular homeopathic medicines for the prevention of upper respiratory tract infections in children. A double-blind randomized placebo controlled trial. Br J Clin Pharmacol 2005;59:447-55.|
|38||Steinsbekk A, Lewith G, Fønnebø V, Bentzen N. An exploratory study of the contextual effect of homeopathic care. A randomised controlled trial of homeopathic care vs. self-prescribed homeopathic medicine in the prevention of upper respiratory tract infections in children. Prev Med 2007;45:274-9.|
|39||Steinsbekk A, Fønnebø V, Lewith G, Bentzen N. Homeopathic care for the prevention of upper respiratory tract infections in children: A pragmatic, randomised, controlled trial comparing individualised homeopathic care and waiting-list controls. Complement Ther Med 2005;13:231-8.|
|40||Beghi GM, Morselli-Labate AM. Does homeopathic medicine have a preventive effect on respiratory tract infections? A real life observational study. Multidiscip Respir Med 2016;11:12.|
|41||Schmiedel V, Klein P. A complex homeopathic preparation for the symptomatic treatment of upper respiratory infections associated with the common cold: An observational study. Explore (NY) 2006;2:109-14.|
|42||Derasse M, Klein P, Weiser M. The effects of a complex homeopathic medicine compared with acetaminophen in the symptomatic treatment of acute febrile infections in children: An observational study. Explore (NY) 2005;1:33-9.|
|43||Rabe A, Weiser M, Klein P. Effectiveness and tolerability of a homoeopathic remedy compared with conventional therapy for mild viral infections. Int J Clin Pract 2004;58:827-32.|
|44||Ammerschläger H, Klein P, Weiser M, Oberbaum M. Treatment of inflammatory diseases of the upper respiratory tract-comparison of a homeopathic complex remedy with xylometazoline. Forsch Komplementarmed Klass Naturheilkd 2005;12:24-31.|
|45||Grimaldi-Bensouda L, Bégaud B, Rossignol M, Avouac B, Lert F, Rouillon F, et al. Management of upper respiratory tract infections by different medical practices, including homeopathy, and consumption of antibiotics in primary care: The EPI3 cohort study in France 2007-2008. PLoS One 2014;9:e89990.|
|46||Haidvogl M, Riley DS, Heger M, Brien S, Jong M, Fischer M, et al. Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting. BMC Complement Altern Med 2007;7:7.|
|47||Riley D, Fischer M, Singh B, Haidvogl M, Heger M. Homeopathy and conventional medicine: An outcomes study comparing effectiveness in a primary care setting. J Altern Complement Med 2001;7:149-59.|
|48||Trichard M, Chaufferin G, Nicoloyannis N. Pharmacoeconomic comparison between homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in children. Homeopathy 2005;94:3-9.|
|49||Nayak C, Singh V, Singh K, Singh H, Oberai P, Roja V, et al. A multi-centric open clinical trial to evaluate the usefulness of 13 predefined homeopathic medicines in the management of acute rhinitis in children. Int J high dilution Res 2010;9:30-42.|
|50||Michalsen A, Uehleke B, Stange R. Safety and compliance of a complex homeopathic drug (Contramutan N Saft) in the treatment of acute respiratory tract infections: A large observational (non-interventional) study in children and adults focussing on homeopathy specific adverse reactions ver. Regul Toxicol Pharmacol 2015;72:179-84.|
|51||Central Council for Research in Homeopathy. Acute respiratory infections. In: Clinical Researh Studies-Series III. New Delhi: Central Council for Research in Homeopathy; 2010. p. 1-9.|
|52||Ramchandani NM. Homoeopathic treatment of upper respiratory tract infections in children: Evaluation of thirty case series. Complement Ther Clin Pract 2010;16:101-8.|
|53||Mathie RT, Ulbrich-Zürni S, Viksveen P, Roberts ER, Baitson ES, Legg LA, et al. Systematic review and meta-analysis of randomised, other-than-placebo controlled, trials of individualised homeopathic treatment. Homeopathy 2018;107:229-43.|
|54||Chakraborty P, Lamba C, Nayak D, John M, Sarkar D, Poddar A, et al. Effect of individualized homoeopathic treatment in influenza like illness: A multicenter, single blind, randomized, placebo controlled study. Indian J Res Homoeopath 2013;7:22.|
|55||Siqueira CM, Homsani F, da Veiga VF, Lyrio C, Mattos H, Passos SR, et al. Homeopathic medicines for prevention of influenza and acute respiratory tract infections in children: Blind, randomized, placebo-controlled clinical trial. Homeopathy 2016;105:71-7.|
|56||Mathie RT, Baitson ES, Frye J, Nayak C, Manchanda RK, Fisher P. Homeopathic treatment of patients with influenza-like illness during the 2009 A/H1N1 influenza pandemic in India. Homeopathy 2013;102:187-92.|
|57||Frei H. H1N1-Influeza Epidemic 2011: Experiences with Polarity Analysis. Spectr Homeopath 2011;3:26-37.|
|58||Vincent S, Demonceaux A, Deswarte D, Scimeca D, Bordet MF. Management of influenza-like illness by homeopathic and allopathic general practitioners in France during the 2009-2010 influenza season. J Altern Complement Med 2013;19:146-52.|
|59||Danno K, Cognet-Dementhon B, Thevenard G, Duru G, Allaert FA, Bordet MF. Effectiveness of homeopathic medicine associated with allopathic medicine in the outpatient management of influenza-like illnesses or ear, nose, and throat disorders by pharmacists. J Manag Care Pharm 2013;19:631-41.|
|60||Gadugu S, Nyapati SR, Sastry GL. An open observational study on efficacy of miasmatic prescription in the prevention of Japanese Encephalitis. Homeopathy 2014;103:78-9.|
|61||Oberai P, Varanasi R, Padmanabhan M, Upadhyaya A, Singh S, Singh SP, et al. Effectiveness of homeopathic medicines as add-on to institutional management protocol for acute encephalitis syndrome in children: An open-label randomized placebo-controlled trial. Homeopathy 2018;107:161-71.|
|62||Manchanda R, Oberai P, Prasad R, Roja V, Singh S, Singh N, et al. Evaluation of homoeopathic medicines as add-on to institutional management protocol in Acute Encephalitis Syndrome: An exploratory observational comparative study. Indian J Res Homoeopath 2015;9:34.|
|63||Nair KR, KurupTN, Bonthu SJ, Aggarwal A, Varanasi R, Nayak D, Padmanabhan M, et al. Homoeopathic Genus Epidemicus ′Bryonia alba′ as a prophylactic during an outbreak of Chikungunya in India: A cluster -randomised, double-blind, placebo-controlled trial. Indian J Res Homoeopath 2014;8:160-5.|
|64||Wadhwani GG. Homeopathic drug therapy. Homeopathy in Chikungunya Fever and Post-Chikungunya Chronic Arthritis: An observational study. Homeopathy 2013;102:193-8.|
|65||Nayak D, Chadha V, Jain S, Nim P, Sachdeva J, Sachdeva G, et al. Effect of adjuvant homeopathy with usual care in management of thrombocytopenia due to dengue: A comparative cohort study. Homeopathy 2019;108:150-7.|
|66||Saeed-ul-Hassan S, Tariq I, Khalid A, Karim S. Comparative clinical study on the effectiveness of homeopathic combination remedy with standard maintenance therapy for dengue fever. Trop J Pharm Res 2013;12:767-70.|
|67||Jacobs J, Fernandez EA, Merizalde B, Avila-Montes GA, Crothers D. The use of homeopathic combination remedy for dengue fever symptoms: A pilot RCT in Honduras. Homeopathy 2007;96:22-6.|
|68||Nunes LA. Contribution of homeopathy to the control of an outbreak of dengue in Macaé, Rio de Janeiro. Int J High Dilution Res 2008;7:186-92.|
|69||Mahesh S, Mahesh M, Vithoulkas G. Could homeopathy become an alternative therapy in dengue fever? An example of 10 case studies. J Med Life 2018;11:75-82.|
|70||Rath P, Arya BS, Vichitra AK, Singh U. Case series of dengue treated with homoeopathic intervention. Homœopathic Links 2019;32:31-5.|
|71||Shah R. A clinical evaluation of a hepatitis C Nosode in the treatment of hepatitis C. J Altern Complement Med 2016;22:197-203.|
|72||Rastogi DP, Singh VP, Singh V, Dey SK, Rao K. Homeopathy in HIV infection: A trial report of double-blind placebo controlled study. Br Homeopath J 1999;88:49-57.|
|73||Mishra N, Singh V, Dey SK, Murty KB, Muralidharan KC, Raveendar Ch, et al. Homoeopathic medicines in the management of HIV infection an observational study. Indian J Res Homoeopath 2008;2:31-46.|
|74||Muraleedharan KC, Dey SK, Prasad P, Siddiqui VA, Dixit R, Singh V, et al. Effectiveness of homoeopathic medicines in HIV patients-A clinical trial. Indian J Res Homoeopat 2010;4:29-36.|
|75||Shah R. Clinical trial for evaluation of a Human Immunodeficiency Virus nosode in the treatment for Human Immunodeficiency Virus-Infected individuals. Indian J Res Homoeopath 2015;9:25.|
|76||World Health Organization. Tuberculosis. Geneva: World Health Organization; 2020.|
|77||Chand KS, Manchanda RK, Mittal R, Batra S, Banavaliker JN, De I. Homeopathic treatment in addition to standard care in multi drug resistant pulmonary tuberculosis: A randomized, double blind, placebo controlled clinical trial. Homeopathy 2014;103:97-107.|
|78||Chand KS, Kapoor P. Case reports on integrated management of tubercular disease. Homeopathy 2017;106:214-22.|
|79||Goyal KK. Two cases of pulmonary TB treated with homeopathy. Homeopathy 2002;91:43-6.|
|80||Chand SK, Manchanda RK, Batra S, Mittal R. Homeopathy in the treatment of tubercular lymphadenitis (TBLN)--an Indian experience. Homeopathy 2011;100:157-67.|
|81||Bracho G, Varela E, Fernández R, Ordaz B, Marzoa N, Menéndez J, et al. Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control. Homeopathy 2010;99:156-66.|
|82||Nayak C, Singh V, Singh K, Singh H, Chakraborty PS, Kaushik S, et al. CLINICAL RESEARCH A prospective multicentre observational study to evaluate the role of homeopathic therapy with a group of predefined homoeopathic medicines in the management of gastroenteritis. Indian J Res Homoeopath 2008;2:28-35.|
|83||Nayak C, Singh V, Singh K, Singh H, Chakravorty P, Kaushik S, et al. A prospective multicentre observational study to evolve the usefulness of the nine predefined homeopathic medicines in furunculosis. Homoeopath Links 2010;23:60-3.|
|84||Nayak C, Singh V, Singh H, Siddiqui V, Gupta J, Mishra A, et al. A prospective multicentre observational study to evolve the usefulness of group of homoeopathic medicines in the management of acute tracheobronchitis. Int J Bio Res 2010;2:9-14.|
|85||Gaertner K, von Ammon K, Frei-Erb M: Individualized Homeopathic Treatment in Women with Recurrent Cystitis: A Retrospective Case Series. Complement Med Res Epub ahead of print 16 Jan 2016. DOI: 10.1159/000504317.|
|86||Nayak C, Singh V, Singh VP, Oberai P, Roja V, Shitanshu SS, et al. Homeopathy in chronic sinusitis: A prospective multi-centric observational study. Homeopathy 2012;101:84-91.|
|87||Witt CM, Lüdtke R, Willich SN. Homeopathic treatment of patients with chronic sinusitis: A prospective observational study with 8 years follow-up. BMC Ear Nose Throat Disord 2009;9:7.|
|88||Zabolotnyi DI, Kneis KC, Richardson A, Rettenberger R, Heger M, Kaszkin-Bettag M, et al. Efficacy of a complex homeopathic medication (Sinfrontal) in patients with acute maxillary sinusitis: A prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial. Explore 2007;3:98-109.|
|89||Adler M. Efficacy and safety of a fixed-combination homeopathic therapy for sinusitis. Adv Ther 1999;16:103-11.|
|90||Friese KH, Zabalotnyi DI. [Homeopathy in acute rhinosinusitis: A double-blind, placebo controlled study shows the efficiency and tolerability of a homeopathic combination remedy]. HNO 2007;55:271-7.|
|91||Sharma SR, Murty KB, Sehegal GC, Sharma B, Bharatalaxmi, Raju K KS. Clinical evaluation of homoeopathic medicines in sinusitis. Indian J Res Homoeopath 2007;1:26-37.|
|92||Pannek J, Pannek-Rademacher S, Jus M, Jus M. Usefulness of classical homoeopathy for the prevention of urinary tract infections in patients with neurogenic bladder dysfunction: A case series. Indian J Res Homoeopath 2014;8:31.|
|93||Mazzoli S, Cai T, Meacci F, Addonisio P, Dorfman P, Hospital SM. High risk human papillomavirus genital infections in asymptomatic population: Effective Micro Immunother 2012;11:134-5.|
|94||Central Council for Research in Homoeopathy. Dysentery. In: Clinical Researh Studies -Series III. New Delhi: Central Council for Research in Homoeopathy; 2010. p. 10-6.|
|95||Central Council for Research in Homoeopathy. Tonsillitis. In: Clinical Researh Studies -Series III. Central Council for Research in Homoeopathy; 2010. p. 54-62.|
|96||Palm J, Kishchuk VV, Ulied À, Fernández JP, De Jaegere S, Jong MC, et al. Effectiveness of an add-on treatment with the homeopathic medication SilAtro-5-90 in recurrent tonsillitis: An international, pragmatic, randomized, controlled clinical trial. Complement Ther Clin Pract 2017;28:181-91.|
|97||Malapane E, Solomon EM, Pellow J. Efficacy of a homeopathic complex on acute viral tonsillitis. J Altern Complement Med 2014;20:868-73.|
|98||Rajendran ES. Molluscum contagiosum: A case series. Homeopathy 2002;91:255-9.|
|99||Goda C, Tamboli P, Sharmila Patil SV. Role of homoeopathic treatment in scabies infection in adivasichildren attending ashram shalas (resident schools). Indian J Res Homoeopath 2010;4:33-40.|
|100||Central Council for Research in Homoeopathy. Periodontitis. In: Clinical Researh Studies -Series III. New Delhi: Central Council for Research in Homoeopathy; 2010. p. 42-6.|
|101||Frass M, Linkesch M, Banyai S, Resch G, Dielacher C, Löbl T, et al. Adjunctive homeopathic treatment in patients with severe sepsis: A randomized, double-blind, placebo-controlled trial in an intensive care unit. Homeopathy 2005;94:75-80.|
|102||Witt A, Kaufmann U, Bitschnau M, Tempfer C, Ozbal A, Haytouglu E, et al. Monthly itraconazole versus classic homeopathy for the treatment of recurrent vulvovaginal candidiasis: A randomised trial. BJOG 2009;116:1499-505.|
|103||Mathie RT, Lloyd SM, Legg LA, Clausen J, Moss S, Davidson JR, et al. Randomised placebo-controlled trials of individualised homeopathic treatment: Systematic review and meta-analysis. Syst Rev 2014;3:142.|
|104||Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005;366:726-32.|
|105||Rutten AL, Stolper CF. The 2005 meta-analysis of homeopathy: The importance of post-publication data. Homeopathy 2008;97:169-77.|
|106||Jacobs J, Fisher P. Polypharmacy, multimorbidity and the value of integrative medicine in public health. Eur J Integr Med 2013;5:4-7.|
|107|| Frei H. Homeopathic treatment of multimorbid patients: A prospective outcome study with polarity analysis. Homeopathy 2015;104:57-65.|
|108||Goodwin G, Fleischhacker W, Arango C, Baumann P, Davidson M, de Hert M, et al. Advantages and disadvantages of combination treatment with antipsychotics ECNP Consensus Meeting, March 2008, Nice. Eur Neuropsychopharmacol 2009;19:520-32.|