Therapeutic potential of traditional herbal medicine against multidrug-resistant pulmonary infections: Based on clinical and pharmacodynamic evidence.

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional herbal medicine has been used for centuries to treat respiratory infections, with documented historical applications for conditions characterized by persistent fever, productive cough, and lung inflammation. These traditional preparations represent indigenous medical knowledge that may offer alternative approaches to modern antibiotic-resistant pulmonary infections, particularly given the global crisis of antimicrobial resistance and diminishing treatment options.

AIM OF THE STUDY: To systematically evaluate the clinical efficacy and pharmacodynamic basis of traditional herbal medicine in treating multidrug-resistant pulmonary infections through bi-directional validation of clinical and laboratory evidence.

RESULTS

From 16,896 records, we identified 100 studies examining 42 traditional preparations against multidrug-resistant pulmonary pathogens. However, evidence quality was highly unbalanced: only Tanreqing injection possessed sufficient data for meta-analysis, demonstrating modest but significant improvements in clinical efficacy (RR = 1.20, 95 %CI: 1.12-1.28) and bacterial clearance (RR = 1.29, 95 %CI: 1.12-1.49) based on 596 patients. Most other preparations relied on small, poorly controlled studies. Bi-directional validation revealed that merely nine preparations had both clinical and pharmacodynamic evidence. Laboratory studies consistently demonstrated synergistic effects with antibiotics, with some combinations achieving substantial MIC reductions (up to 87.52 %). Animal studies confirmed anti-inflammatory properties and improved survival rates, though translation to clinical settings remains uncertain.

CONCLUSIONS

Traditional herbal medicine shows potential as complementary therapy for multidrug-resistant pulmonary infections through multi-target therapeutic actions and antibiotic synergy. However, evidence quality remains heterogeneous, with most preparations lacking sufficient high-quality clinical data. Future research should prioritize larger randomized trials, standardized microbiological reporting, and mechanistic investigation to optimize clinical application.