Pelargonium: Sinusitis, Sore Throat and Colds

Table of Contents

1. Three Different Conditions
2. The Common Cold Evidence
3. Acute Sinusitis
4. The 2023 Network Meta-Analysis
5. Sore Throat and Tonsillitis in Children
6. Children Under Six
7. Cough as a Symptom
8. The Antibiotic Question
9. Why the Certainty Ratings Differ
10. The Common Cold Registration in the EU
11. Where This Evidence Stands
12. Key Research Papers
13. Connections

Three Different Conditions

Colds, sinusitis and sore throats are often lumped together as "upper respiratory infections", but researchers study them separately because they behave differently:

• The common cold is a viral infection of the nose and throat. A review in a family-medicine journal notes that it is generally caused by viruses, is treated by relieving symptoms, and that antibiotics are not effective for it in children or adults.
• Acute rhinosinusitis is inflammation of the nose and the sinuses (air-filled spaces in the skull around the nose). Researchers distinguish post-viral sinusitis (following a cold), bacterial sinusitis and chronic sinusitis, and study them separately.
• Acute tonsillitis or tonsillopharyngitis is inflammation of the tonsils and throat. A 2023 review notes that most childhood cases have a viral origin and do not call for antibiotics.

A remedy can have evidence for one of these and not the others, which is why each is taken in turn below.

The Common Cold Evidence

The Cochrane review of pelargonium for acute respiratory infections (2013 update) found one study in the common cold. It showed efficacy after ten days of treatment but not after five, and the reviewers rated it as very low quality evidence. Their overall conclusion was that the extract "may be effective in alleviating symptoms of acute rhinosinusitis and the common cold in adults, but doubt exists".

A 2012 review of cold treatments in a family-medicine journal listed Pelargonium sidoides (geranium) extract among the products that improve cold symptoms in children, alongside vapour rub, zinc sulphate and buckwheat honey. That review summarised published trials rather than adding new ones.

A Swiss review of non-antibiotic approaches to preventing infections (2022) listed pelargonium among plant medicines considered promising, and added that a high level of evidence is required before specific recommendations for their use can be made.

Acute Sinusitis

The Cochrane review found one study in 103 adults with sinusitis. It showed a significant treatment effect on complete resolution of symptoms by day 21 (risk ratio 0.43, 95% confidence interval 0.30 to 0.62). The reviewers rated it as very low quality evidence. In its first version (2008) the review noted that this study was unpublished at the time.

A 2016 German-language systematic review of herbal medicines for acute rhinosinusitis found seven trials of several products. It described the extract as appearing "useful", while noting that the risk of bias varied between trials and that the small number of trials and their mixed methodological quality meant more research was needed.

A 2025 narrative review of how the extract might act in acute rhinosinusitis summarised laboratory and animal studies suggesting effects on immune signalling, and concluded that, given the small number of studies, the level of evidence is low.

The 2023 Network Meta-Analysis

A network meta-analysis compares many treatments at once, including ones never tested head to head, by linking trials through shared comparators such as placebo. In 2023, a team in Vietnam and Thailand analysed 47 randomised trials of 18 herbal medicines across six forms of rhinosinusitis and graded the certainty of each finding with the GRADE system.

• Common cold: Pelargonium sidoides had the most beneficial effect on symptom improvement, with moderate certainty.
• Acute post-viral rhinosinusitis: cineole (a eucalyptus-oil compound) and Pelargonium sidoides were the most effective for controlling symptoms, with moderate certainty.
• Bacterial and chronic sinusitis: evidence for herbal medicines was restricted to a limited number of studies.

The authors called for further studies with adequate sample sizes and long-term follow-up. A ranking of "most effective" in a network analysis describes relative position among the treatments compared; it does not by itself say how large the benefit is.

Sore Throat and Tonsillitis in Children

A 2023 systematic review searched six databases for complementary, alternative and integrative treatments of acute tonsillitis in children. Of 321 articles, only five met its criteria, covering herbal medicines (including the pelargonium extract), a homeopathic complex and Ayurvedic medicines. The authors found that the clinical studies indicated improvement of symptoms and good tolerability, but that the quality and quantity of studies were insufficient to make a reliable conclusion about effectiveness, and that more trials were urgently needed.

The Cochrane review similarly found no valid data for acute respiratory infections other than bronchitis, sinusitis and the common cold. Sore throat caused by streptococcal bacteria ("strep throat") is a separate condition with its own established treatment.

Children Under Six

A 2018 analysis gathered seven studies that included 1,067 children under six who had received the extract. Outside bronchitis, it found one open-label study without a comparison group in acute tonsillopharyngitis and one in acute rhinosinusitis, in which nearly all children recovered or improved during treatment, and one further observational study of mixed respiratory infections. Studies without a comparison group cannot separate the effect of a treatment from natural recovery, which is expected in these mostly self-limiting infections. Two of the analysis's authors worked in the manufacturer's clinical research department.

The EU monograph (2024) lists doses for children from three years and states that oral use under three is not recommended because of concerns requiring medical advice. Its safety warnings are described in Liver Injury Reports and Safety.

Cough as a Symptom

A 2015 systematic review and meta-analysis looked at herbal medicines for cough as a symptom of upper respiratory infections and colds. It included 34 randomised trials with 7,083 participants. For pelargonium (11 trials) it found a risk ratio of 4.60 for cough improvement compared with placebo, which it rated as moderate evidence. It rated the evidence for andrographis and for an ivy/primrose/thyme combination as strong, and for echinacea as limited.

The 2018 meta-analysis of herbal medicine in children with respiratory infections pooled six placebo-controlled pelargonium trials and found a responder-rate risk ratio of 2.56, rated as moderate evidence for efficacy and safety. Most of the trials in both analyses were bronchitis trials, so these figures largely reflect the bronchitis evidence described in Acute Bronchitis Trials.

The Antibiotic Question

Much of the interest in pelargonium comes from antibiotic stewardship — the effort to avoid prescribing antibiotics for infections they cannot help, because overuse drives antibiotic resistance. A 2023 review of the mechanistic evidence for pelargonium, andrographis, echinacea and an ivy/primrose/thyme combination framed these herbs as possible non-antibiotic treatments for uncomplicated respiratory infections.

So far only one trial has tested antibiotic use as a main outcome. In the 2026 Swiss PHYTOBRONCH trial in adults with acute bronchitis, antibiotic use was 17.4 per cent with the extract versus 25.2 per cent with usual care, a difference that was not statistically significant. The authors suggested larger trials to clarify whether the extract has a role in antimicrobial stewardship.

Why the Certainty Ratings Differ

Readers may notice that the same remedy is described as "very low", "low" and "moderate" quality evidence by different reviews. Several things explain this:

• Different questions. The Cochrane review graded each condition separately; the cough meta-analysis pooled trials across conditions; the network meta-analysis graded comparisons within each type of sinusitis.
• Different methods. GRADE ratings start from the trial design and move down for risk of bias, inconsistency between trials, imprecision and suspected publication bias. Reviewers can weigh those factors differently.
• Few trials per condition. A single trial, however positive, rarely earns a high rating. For colds and sinusitis the Cochrane team had one trial each.

No review has rated the evidence for pelargonium in any of these conditions as high quality.

The Common Cold Registration in the EU

The European Union herbal monograph on pelargonium root (Revision 2, adopted May 2024) covers a single indication: "Traditional herbal medicinal product for the symptomatic treatment of common cold". The monograph states that the product is for use in that indication "exclusively based upon long-standing use".

That wording is important. Traditional-use registration in the EU certifies that a preparation has been in medicinal use for at least 30 years (15 of them in the EU) and is plausibly safe; it does not certify that clinical trials have proven it effective. The EMA's assessment report explains that the committee chose the common-cold indication because bronchitis needs medical diagnosis and supervision, not because the cold evidence was stronger. The monograph also states that a doctor or qualified health care practitioner is to be consulted if symptoms last longer than a week or worsen.

Where This Evidence Stands

• Common cold: one trial in the Cochrane review (very low quality); moderate certainty in a 2023 network meta-analysis; the only indication in the EU monograph, registered on traditional use.
• Acute sinusitis: one trial of 103 adults (very low quality); moderate certainty for post-viral rhinosinusitis in the 2023 network meta-analysis; little evidence for bacterial or chronic sinusitis.
• Sore throat and tonsillitis: too few and too weak studies for a reliable conclusion.
• Antibiotic use: one trial, no significant reduction.

Sinus pain with high fever, symptoms that worsen after initially improving, a sore throat with difficulty swallowing or breathing, and illness in a young child are situations where questions belong with a clinician.

Key Research Papers

1. Timmer A, Günther J, Motschall E, et al. Pelargonium sidoides extract for treating acute respiratory tract infections. The Cochrane database of systematic reviews. 2013;2013(10):CD006323. PubMed PMID: 24146345
2. Timmer A, Günther J, Rücker G, et al. Pelargonium sidoides extract for acute respiratory tract infections. The Cochrane database of systematic reviews. 2008;(3):CD006323. PubMed PMID: 18646148
3. Hoang MP, Seresirikachorn K, Chitsuthipakorn W, et al. Herbal Medicines for Rhinosinusitis: A Systematic Review and Network Meta-analysis. Current allergy and asthma reports. 2023;23(2):93-109. PubMed PMID: 36609950
4. Koch AK, Klose P, Lauche R, et al. [A Systematic Review of Phytotherapy for Acute Rhinosinusitis]. Forschende Komplementarmedizin (2006). 2016;23(3):165-9. PubMed PMID: 27404100
5. Perić A, Vezmar Kovačević S, Barać A, et al. Immunomodulatory Effects of Pelargonium sidoides Extract (EPs7630) in the Treatment of Acute Rhinosinusitis. Expert reviews in molecular medicine. 2025;27:e25. PubMed PMID: 40660733
6. Büttner R, Schwermer M, Ostermann T, et al. Complementary and alternative medicine in the (symptomatic) treatment of acute tonsillitis in children: A systematic review. Complementary therapies in medicine. 2023;73:102940. PubMed PMID: 36868289
7. Kamin W, Funk P, Seifert G, et al. EPs 7630 is effective and safe in children under 6 years with acute respiratory tract infections: clinical studies revisited. Current medical research and opinion. 2018;34(3):475-485. PubMed PMID: 29119837
8. Wagner L, Cramer H, Klose P, et al. Herbal Medicine for Cough: a Systematic Review and Meta-Analysis. Forschende Komplementarmedizin (2006). 2015;22(6):359-68. PubMed PMID: 26840418
9. Anheyer D, Cramer H, Lauche R, et al. Herbal Medicine in Children With Respiratory Tract Infection: Systematic Review and Meta-Analysis. Academic pediatrics. 2018;18(1):8-19. PubMed PMID: 28610802
10. Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adults. American family physician. 2012;86(2):153-9. PubMed PMID: 22962927
11. Seneghini M, Albrich WC. [Non-antibiotic Prophylaxis of Infections]. Praxis. 2022;111(8):463-468. PubMed PMID: 35673840
12. Veldman LBM, Belt-Van Zoen E, Baars EW. Mechanistic Evidence of Andrographis paniculata (Burm. f.) Wall. ex Nees, Pelargonium sidoides DC., Echinacea Species and a Combination of Hedera helix L., Primula veris L./Primula elatior L. and Thymus vulgaris L./Thymus zygis L. in the Treatment of Acute, Uncomplicated Respiratory Tract Infections: A Systematic Literature Review and Expert Interviews. Pharmaceuticals (Basel, Switzerland). 2023;16(9). PubMed PMID: 37765014
13. Bourqui A, Corpataux O, Bonofiglio F, et al. Pelargonium sidoides extract (EPs® 7630) versus usual care for acute bronchitis in Swiss primary care (PHYTOBRONCH): a pragmatic, open-label, randomised controlled trial. NPJ primary care respiratory medicine. 2026;36(1). PubMed PMID: 42014704

PubMed Topic Searches

1. PubMed: Pelargonium sidoides and rhinosinusitis
2. PubMed: Pelargonium sidoides and the common cold
3. PubMed: Pelargonium sidoides and tonsillopharyngitis

Regulatory Source

1. European Medicines Agency, Committee on Herbal Medicinal Products. European Union herbal monograph on Pelargonium sidoides DC; Pelargonium reniforme Curt., radix. Final, Revision 2. EMA/HMPC/648100/2022, 2024. EMA monograph (PDF)

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Connections

• All Herbs
• Pelargonium (Pelargonium sidoides) — the main topic page
• Pelargonium Benefits Deep Dive — the hub for all four articles
• Acute Bronchitis Trials — the larger body of trials
• Liver Injury Reports and Safety — side effects and liver reports
• Umckaloabo History and Wild Harvest — the plant's history
• Common Cold — the condition itself
• Sinusitis — acute and chronic sinus infection
• Tonsillitis — tonsil infection
• Sore Throat — causes and what the evidence shows
• Strep Throat — the bacterial sore throat
• Echinacea: Cold and Flu Prevention — another cold herb with mixed evidence
• Zinc Acetate Lozenges — a cold remedy tested in its own trials
• Honey: Cough Suppressant Evidence — honey for coughs in children

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