The use of herbal medicine to treat microbial infections has gained significant attention over the years. Although antibiotics are necessary for saving lives when used correctly, they are also recognized for various negative side effects. As modern medicine continues to address antimicrobial resistance, the exploration of effective natural and herbal antimicrobials is on the rise. In this article, we will discuss the rise of antibiotic resistance and cutting-edge herbal therapies to combat microbial infections. 

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The Rise of Antibiotic Resistance 

While antibiotic medications are a central component of conventional medicine, the rise of antimicrobial resistance is a pressing global health threat. According to the CDC, antimicrobial resistance is associated with killing 1.27 million people worldwide and almost 5 million deaths in 2019. The implications of antibiotic resistance are profound. Antimicrobial resistance develops due to the overuse and misuse of antibiotics leading to drug-resistant pathogens. As drug-resistant pathogens continue to evolve, physicians confront an inability to treat life-threatening infectious diseases. Due to the ongoing threat of antibiotic resistance, practitioners and researchers have turned to herbal and natural antimicrobials for potential treatment. (11, 47) 

The Top 4 Herbal Antimicrobials

Herbal medicine offers promising benefits in treating microbial infections. Plants contain multiple bioactive compounds that can synergistically target microbial pathogens, making them a valuable alternative to antibiotics. Among the herbal antimicrobial agents studied extensively are Echinacea, Garlic, Oregano, and Goldenseal. (3) 

1. Garlic (Allium sativa)

For centuries, garlic has been admired as an edible plant renowned for its efficacy against bacterial infections. Allicin, the main constituent in garlic is responsible for its antibacterial effects. Allicin possesses antibacterial activity against Gram-negative and Gram-positive bacteria. Garlic interferes with microbial processes by increasing the activity of immune cells and modulating the immune system making it highly effective in treating cold and flu symptoms. Most importantly, allicin is beneficial in treating antibiotic-resistant strains of bacteria (4).

2. Echinacea (Echinacea purpurea)

Echinacea is a flowering plant native to North America. It is used to support the immune system, treat respiratory bacterial infections, and has anti-inflammatory actions. In regards to bacterial infections, Echinacea can reverse proinflammatory cytokine stimulation contributing to its efficacy in treating microbial infections. Due to its medicinal properties, echinacea can be used in the treatment of urinary tract infections, vaginal yeast infections, ear infections, hay fever, and wound healing (20, 27, 45).

3. Oregano Oil (Origanum vulgare)

Oregano is a common herb used widely in the treatment of bacterial infections. The medicinal part of oregano lies within the essential oil, which contains carvacrol and thymol. These constituents have been shown to possess anti-inflammatory, antibacterial, and anti-oxidation effects through bacterial enzyme inhibition, biofilm formation depletion, and cytoplasmic membrane damage. Oregano oil is a fantastic tool for combating respiratory infections, skin ailments, and digestive disorders (12, 16, 46).

4. Goldenseal (Hydrastis canadensis)

Goldenseal is a plant native to North America known to exert broad-spectrum antimicrobial effects against bacteria, fungi, and protozoa. The active constituent in goldenseal is berberine, which studies show to have numerous medicinal actions such as anti-inflammatory, anti-microbial, neuroprotective, and insulin resistance. Regarding its anti-microbial properties, goldenseal has been shown effective in the treatment of seasonal cold/flu, sinusitis, digestive disorders (H. pylori), MRSA, and minor wounds (10, 18, 21, 52)

Evidence-Based Applications of Herbal Antimicrobials

Over the years, clinical studies have highlighted the benefits of herbal antimicrobials in combating microbial infections. When deciding which antimicrobial will be most effective, we can look at the numerous clinical studies and research performed on our favorite herbal allies. 

A study conducted on the efficacy of goldenseal (Hydrastis canadensis) against methicillin-resistant Staphylococcus aureus (MRSA) showed that the alkaloids and flavonoids of the plant exhibit strong anti-microbial benefits. MRSA infection is known to be resistant to many pharmaceutical antibiotics and the emerging study shows that goldenseal is a possible therapeutic alternative (10, 24).

Our next highlighted herb, backed by ample clinical research, is garlic. One study examined the benefits of using garlic extract against oral streptococcus bacteria, the microbe responsible for strep throat. The study examined 30 subjects using a garlic-prepared mouthwash over 5 weeks. Results showed that the garlic mouthwash was an effective treatment in reducing oral streptococci organisms (17, 23).

As previously mentioned, Echinacea is a preferred herbal remedy for bacterial respiratory infections. One study examined the effects of Echinacea purpura against common bacteria that cause upper respiratory tract infections. The results of the study confirmed that Echinacea is effective in deactivating H. influenza, Streptococcus, and Legionella pneumophila. The study also exhibited that Echinacea can reverse the inflammatory response during active microbial infection (8, 9, 45).

Incorporating Herbal Antimicrobials into Treatment Plans

The integration of herbal medicine into treatment plans requires meticulous attention to dosing, potential interactions with pharmaceuticals, and consideration of the patient's holistic health profile. When formulating the treatment plan the practitioner needs to account for the whole person and consider underlying comorbid conditions. Accounting for patient allergies, sensitivities, and preferences when drafting a treatment plan is key to patient success. 

When selecting an herbal anti-microbial for a specific treatment plan, it is important to consider the bioavailability of different herbal preparations. Most herbal medicines come in capsule, tincture, or tea format. It is best to select herbal antimicrobials with standardized extracts to ensure adequate concentration of medicinally active constituents. Lastly, proper education is needed to ensure the patients understand how to implement herbal medicine into their daily lives (14, 19)

Addressing Safety and Quality Concerns

While herbal antimicrobials offer promising benefits in combating microbial infections, it is important to consider the safety and the quality of products. When sourcing any herbal medicine, it is crucial to obtain herbs from reputable companies that follow quality control standards. When searching for reputable companies it is advised to look for products that have been third-party tested and follow Good Manufacturing Practices (GMP). Using products that lack standardized regulations can cause undesired side effects and variability in the effectiveness of the product (53).

Of the herbs discussed in this article, the two that may cause undesired side effects are Echinacea and Oregano oil. When prescribing Echinacea, it is important to avoid prescribing this herb in patients with autoimmune conditions such as multiple sclerosis due to its immunostimulant properties. While oregano oil is generally considered safe for most people, it is imperative to mix the oil with a carrier oil or water to avoid side effects such as burning or internal irritation (6).

Role of Diet and Lifestyle in Supporting Antimicrobial Therapy

Optimizing the effectiveness of anti-microbial therapy involves not only herbal medicine but also the incorporation of nutritional and lifestyle practices. In functional medicine, a comprehensive approach is needed to enhance immune function and combat infections while addressing the root cause of illness. A balanced diet rich in essential nutrients is key to building a strong immune system. 

For optimal results with your antimicrobial treatment plan, it is recommended to include foods rich in vitamins C, D, A, and E as well as zinc and omega-3 fatty acids. As well as including plentiful phytonutrients commonly found in colorful fruits and vegetables. It is imperative to avoid inflammatory foods such as saturated fats and processed sugars. For more information on how to follow these diet recommendations please read up on the Mediterranean Diet (22).

Often, the foundation of good health lies in our daily lifestyle choices. This is where the importance of lifestyle factors becomes apparent. The keys to supporting your body through anti-microbial therapy lie in sound sleep, stress management, proper aerobic exercise, and good hydration (5, 29).

For best immune health it is recommended to obtain 7-9 hours of sleep per night. In addition, monitoring stress levels is crucial for immune health when undergoing anti-microbial treatment. Chronic stress causes a decrease in immune cells and an increase in stress hormone (cortisol) contributing to higher levels of inflammation. By practicing stress management techniques, such as mindfulness meditation, individuals can improve their overall well-being and support their immune systems when undergoing treatment (13).

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Functional Lab Testing in Identifying and Monitoring Infections

Functional lab testing plays a crucial role in the identification of microbial infections. In the context of antimicrobial treatment, functional lab tests allow for healthcare practitioners to monitor the effectiveness of herbal treatment by assessing changes in imbalances and pathogen levels over time. Among the most important tests include comprehensive stool analysis such as the GI-MAP by Diagnostic Solutions and the Microbial Analysis by Genova Diagnostics which all provide detailed information about microbial pathogens and imbalances in the body.

The GI Map test by Diagnostic Solutions is an amazing test to gain insight into gastrointestinal microbial imbalances. This test uses PCR technology to screen for over 50 different pathogenic microbes in the stool that contribute to chronic illness, inflammation, and immune function (26).

The Microbial Analysis lab by Genova Diagnostics provides a thorough culture of the patient's gut flora while also providing possible therapeutic interventions. This test provides the practitioner an insight into which pharmaceutical or botanical anti-microbial will be most effective for the patient (32).

The growing concern of antibiotic resistance has led functional medicine practitioners to research and utilize herbal and natural antimicrobials. Additionally, lifestyle factors and functional lab testing play key roles in supporting antimicrobial therapy and monitoring infection progression. As clinical research continues to grow, the use of herbal medicine in combatting microbial resistance presents a promising avenue for addressing antibiotic resistance.