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Search Health Information    Infection (Holistic)

Infection (Holistic)

About This Condition

Protect your body from infection—the invasion of microorganisms. The best defense? A strong immune system. According to research or other evidence, the following self-care steps may be helpful.
  • See a healthcare provider

    Except for common infections such as a cold, see your provider for help determining the cause and best treatment for your infection

  • Take a multivitamin

    Extra vitamins and minerals daily may help prevent deficiencies that increase your chances of getting an infection

  • Reduce stress

    Work with a counselor or with tapes and other self-help tools to reduce stress, which can impair your immune system

About

About This Condition

Infection is the result of invasion of the body by microorganisms, including bacteria, viruses, or fungi.

Not all microorganisms cause infections in the body, and exposure to a disease-causing microorganism does not always result in symptoms. The immune system plays a large role in determining the body’s ability to fight off infection.

Some examples of infection are common cold/sore throat , influenza , cough , recurrent ear infections , urinary tract infection , yeast infection , athlete’s foot , cold sores , HIV , shingles , and parasites .

Symptoms

Symptoms of infection include localized warmth, redness, swelling, discharge, foul-smelling odor, and pain to the touch. In more serious cases, symptoms may also include fever, chills, nausea, vomiting, diarrhea , and fatigue.

Healthy Lifestyle Tips

Stress can depress the immune system , thus increasing the body’s susceptibility to infection. Coping effectively with stress is important.1 Exercise increases natural killer cell activity, which may also help prevent infections.2

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Balance nutrition
Nutrition contributes to proper immune system function, so support it by restricting sugar, drinking alcohol moderately or not at all, and eating less fat.

Nutrition is a major contributor to the functioning of the immune system, which in turn influences whether or not the body is resistant to infection. Specifically, it makes sense to restrict sugar, because sugar interferes with the ability of white blood cells to destroy bacteria.3 Alcohol also interferes with a wide variety of immune defenses,4 and excessive dietary fat reduces natural killer cell activity.5 However, there is no research investigating whether reducing sugar, alcohol, or fat intake decreases the risk of infection or improves healing.

Uncover your allergies
Food allergies can play a role in recurrent infections. An elimination diet may help you discover sensitivities.

Allergy , including food allergy, has been suggested to predispose people to recurrent infection,6 and many doctors consider allergy treatment for people with recurrent infections. The links between allergy and ear infections ,7 , 8 urinary tract infections in children,9 and yeast vaginitis in women10 , 11 have been documented.

Supplements

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement Why
3 Stars
Andrographis
48 to 60 mg andrographolides in two to three divided doses per day
Andrographis supports the immune system and protects against microbes.

Herbs that support a person’s immune system in the fight against microbes include the following: American ginseng , andrographis , Asian ginseng , astragalus , coriolus, eleuthero , ligustrum , maitake , picrorhiza , reishi , schisandra , and shiitake .

Double-blind trials have shown that common cold symptoms improve12 , 13 and recovery is faster14 when andrographis extract containing 48 to 60 mg andrographolides is taken in three or four divided doses daily, beginning as soon as possible after symptoms appear. In addition, preliminary research in Russia suggests andrographis extract may be effective for the treatment of influenza.15 This extract was also tested for preventing colds in a double-blind study of teenagers.16 After three months, the group taking 5 mg of andrographolides twice daily had only half the number of colds experienced by the placebo group.

Other preliminary17 and double-blind18 , 19 research has shown similar benefits for treating the common cold from a combination of andrographis extract and an eleuthero extract containing 2.0 to 2.4 mg per day eleutherosides.

3 Stars
Vitamin A
See a doctor for evaluation of possible deficiency
Vitamin A plays an important role in immune system function and helps mucous membranes, including those in the lungs, resist invasion by microorganisms.

Nutrients useful for maintaining healthy immune function are also applicable for preventing infections. Vitamin A plays an important role in immune system function and helps mucous membranes, including those in the lungs, resist invasion by microorganisms.20 However, most research shows that while vitamin A supplementation helps people prevent or treat infections in developing countries where deficiencies are common,21 little to no positive effect, and even slight adverse effects, have resulted from giving vitamin A supplements to people in countries where most people consume adequate amounts of vitamin A.22 , 23 , 24 , 25 , 26 , 27 , 28 Moreover, vitamin A supplementation during infections appears beneficial only in certain diseases. An analysis of trials revealed that vitamin A reduces mortality from measles and diarrhea , but not from pneumonia, in children living in developing countries.29 A double-blind trial for vitamin A supplementation in Tanzanian children with pneumonia confirmed its lack of effectiveness for this condition.30 In general, parents in the developed world should not give vitamin A supplements to children unless there is a reason to believe vitamin A deficiency is likely, such as the presence of a condition causing malabsorption (e.g., celiac disease ). However, the American Academy of Pediatrics recommends that all children with measles should be given high-dose vitamin A for several days.

3 Stars
Vitamin C
1 to 4 grams daily
Vitamin C has antiviral activity, and may help prevent viral infections or, in the case of the common cold, reduce the severity and duration of an infection.

Vitamin C has antiviral activity, and may help prevent viral infections31 or, in the case of the common cold , reduce the severity and duration of an infection.32 Most studies on the common cold used 1 to 4 grams of vitamin C per day.

2 Stars
Echinacea
3 to 5 ml of liquid herbal extracts every two hours, or 300 to 600 mg of powdered herb three times per day, or 5 to 6 cups of tea daily
Echinacea is both immune supportive and antimicrobial.

Herbs that support a person’s immune system in the fight against microbes and directly attack microbes include the following: barberry , echinacea , elderberry , goldenseal , licorice , Oregon grape , osha, and wild indigo .

2 Stars
Multivitamin
Follow label directions
A multiple vitamin-mineral formula helped elderly people avoid infections in one double-blind trial.

A multiple vitamin-mineral formula helped elderly people avoid infections in one double-blind trial, but not in another.33 , 34 In a double-blind study of middle-aged and elderly diabetics, supplementation with a multiple vitamin and mineral preparation for one year reduced the risk of infection by more than 80%, compared with a placebo.35 In another double-blind trial, supplements of 100 mcg per day of selenium and 20 mg per day of zinc , with or without additional vitamin C , vitamin E , and beta-carotene , reduced infections in elderly people, though vitamins without minerals had no effect.36 That study suggests that trace minerals may be the most important components of a multiple vitamin and mineral formula for preventing infections.

2 Stars
Multivitamin (Type 2 Diabetes)
Follow label instructions
Supplementing with a multivitamin–mineral may give your body the nutrients it needs to help prevent common infections.
In a double-blind study, supplementation of middle-aged and elderly diabetics with a multiple vitamin and mineral preparation for one year reduced the risk of infection by more than 80%, compared with a placebo.37
2 Stars
Probiotics
Consult a qualified healthcare practitioner
Lactobacillus acidophilus produces acids that kill invading bacteria. These and other probiotics inhibit the growth of potentially infectious organisms and have been shown to be effective against some infections.

Lactobacillus acidophilus (the friendly bacteria found in yogurt) produces acids that kill invading bacteria.38 The effective amount of acidophilus depends on the strain used, as well as the concentration of viable organisms. These and other friendly bacteria known as probiotics inhibit the growth of potentially infectious organisms (pathogens) by producing acids, hydrogen peroxide, and natural antibiotics called bacteriocins and microcins, by utilizing nutrients needed by pathogens, by occupying attachment sites on the gut wall that would otherwise be available to pathogens, and by stimulating immune attacks on pathogens. Infections that have been successfully prevented or treated with friendly bacteria include infectious diarrhea , vaginitis , and urinary tract infections .39 , 40

2 Stars
Selenium
100 mcg per day with 20 mg per day of zinc
Selenium supplements have been reported to help reduce infections in elderly people.

Most,41 , 42 but not all,43 double-blind studies have shown that elderly people have better immune function and reduced infection rates when taking a multiple vitamin-mineral formula. In one double-blind trial, supplements of 100 mcg per day of selenium and 20 mg per day of zinc , with or without additional vitamin C , vitamin E , and beta-carotene , reduced infections in elderly people, though vitamins without minerals had no effect.44 Burn victims have also experienced fewer infections after receiving trace mineral supplements in double-blind research.45 These studies suggest that trace minerals may be the most important micronutrients for enhancing immunity and preventing infections in the elderly.

2 Stars
Zinc
Refer to label instructions
Zinc deficiencies can impair immune function. Supplementing with zinc has been shown to increase immune function in healthy people. Zinc lozenges have been found helpful in against the common cold.

Marginal deficiencies of zinc result in immune function impairments.46 In a double-blind study of healthy elderly people, supplementing with 45 mg of zinc per day for one year significantly reduced the frequency of infections.47 Some doctors recommend lower amounts of supplemental zinc for people experiencing recurrent infections, such as 25 mg per day for adults and even lower amounts for children (depending on body weight). Zinc lozenges have been found helpful in some studies for the common cold . Long-term zinc supplementation should in most cases be accompanied by a copper supplement in order to prevent zinc-induced copper deficiency.

1 Star
American Ginseng
Refer to label instructions
American ginseng supports the immune system and protects against microbes.

Herbs that support a person’s immune system in the fight against microbes include the following: American ginseng , andrographis , Asian ginseng , astragalus , coriolus, eleuthero , ligustrum , maitake , picrorhiza , reishi , schisandra , and shiitake .

1 Star
Asian Ginseng
Refer to label instructions
Asian ginseng supports the immune system and protects against microbes.

Herbs that support a person’s immune system in the fight against microbes include the following: American ginseng , andrographis , Asian ginseng , astragalus , coriolus, eleuthero , ligustrum , maitake , picrorhiza , reishi , schisandra , and shiitake .

1 Star
Astragalus
Refer to label instructions
Astragalus supports the immune system and protects against microbes.

Herbs that support a person’s immune system in the fight against microbes include the following: American ginseng , andrographis , Asian ginseng , astragalus , coriolus, eleuthero , ligustrum , maitake , picrorhiza , reishi , schisandra , and shiitake .

1 Star
Barberry
Refer to label instructions
Barberry is both immune supportive and antimicrobial.

Herbs that support a person’s immune system in the fight against microbes and directly attack microbes include the following: barberry , echinacea , elderberry , goldenseal , licorice , Oregon grape , osha, and wild indigo .

1 Star
Chaparral
Refer to label instructions
Chaparral is an herb that directly attack microbes.
1 Star
Elderberry
Refer to label instructions
Elderberry is both immune supportive and antimicrobial.

Herbs that support a person’s immune system in the fight against microbes and directly attack microbes include the following: barberry , echinacea , elderberry , goldenseal , licorice , Oregon grape , osha, and wild indigo .

1 Star
Eleuthero
Refer to label instructions
Eleuthero supports the immune system and protects against microbes.
Herbs that support a person’s immune system in the fight against microbes include the following: American ginseng , andrographis , Asian ginseng , astragalus , coriolus, eleuthero , ligustrum , maitake , picrorhiza , reishi , schisandra , and shiitake .

Double-blind trials have shown that common cold symptoms improve48 , 49 and recovery is faster50 when andrographis extract containing 48 to 60 mg andrographolides is taken in three or four divided doses daily, beginning as soon as possible after symptoms appear. In addition, preliminary research in Russia suggests andrographis extract may be effective for the treatment of influenza.51 This extract was also tested for preventing colds in a double-blind study of teenagers.52 After three months, the group taking 5 mg of andrographolides twice daily had only half the number of colds experienced by the placebo group.

Other preliminary53 and double-blind54 , 55 research has shown similar benefits for treating the common cold from a combination of andrographis extract and an eleuthero extract containing 2.0 to 2.4 mg per day eleutherosides.

1 Star
Eucalyptus
Refer to label instructions
Eucalyptus is an herb that directly attack microbes.

Caution: Do not use eucalyptus oil internally without supervision by a healthcare professional. As little as 3.5 ml of the oil taken internally has proven fatal.

Herbs that directly attack microbes include the following: chaparral , eucalyptus , garlic , green tea , lemon balm (antiviral), lomatium , myrrh , olive leaf , onion , oregano , pau d’arco (antifungal), rosemary , sage , sandalwood , St. John’s wort , tea tree oil , thyme , and usnea .
1 Star
Garlic
Refer to label instructions
Garlic is an herb that directly attack microbes.
1 Star
Goldenseal
Refer to label instructions
Goldenseal is both immune supportive and antimicrobial.

Herbs that support a person’s immune system in the fight against microbes and directly attack microbes include the following: barberry , echinacea , elderberry , goldenseal , licorice , Oregon grape , osha, and wild indigo .

1 Star
Green Tea
Refer to label instructions
Green tea is an herb that directly attack microbes.
1 Star
Lemon Balm
Refer to label instructions
Lemon balm is an antiviral and antimicrobial herb.
1 Star
Ligustrum
Refer to label instructions
Ligustrum supports the immune system and protects against microbes.

Herbs that support a person’s immune system in the fight against microbes include the following: American ginseng , andrographis , Asian ginseng , astragalus , coriolus, eleuthero , ligustrum , maitake , picrorhiza , reishi , schisandra , and shiitake .

1 Star
Lomatium
Refer to label instructions
Lomatium is an herb that directly attack microbes.
1 Star
Maitake
Refer to label instructions
Maitake supports the immune system and protects against microbes.

Herbs that support a person’s immune system in the fight against microbes include the following: American ginseng , andrographis , Asian ginseng , astragalus , coriolus, eleuthero , ligustrum , maitake , picrorhiza , reishi , schisandra , and shiitake .

1 Star
Myrrh
Refer to label instructions
Myrrh is an herb that directly attack microbes.
1 Star
Olive Leaf
Refer to label instructions
Olive leaf is an herb that directly attack microbes.
1 Star
Onion
Refer to label instructions
Onion is an herb that directly attack microbes.
1 Star
Oregano
Refer to label instructions
Oregano is an herb that directly attack microbes.
1 Star
Oregon Grape
Refer to label instructions
Oregon grape is both immune supportive and antimicrobial.

Herbs that support a person’s immune system in the fight against microbes and directly attack microbes include the following: barberry , echinacea , elderberry , goldenseal , licorice , Oregon grape , osha, and wild indigo .

1 Star
Osha
Refer to label instructions
Osha is both immune supportive and antimicrobial.

Herbs that support a person’s immune system in the fight against microbes and directly attack microbes include the following: barberry , echinacea , elderberry , goldenseal , licorice , Oregon grape , osha, and wild indigo .

1 Star
Pau d’Arco
Refer to label instructions
Pau d’Arco is an herb that directly fights both microbes and fungus.
1 Star
Picrorhiza
Refer to label instructions
Picrorhiza supports the immune system and protects against microbes.

Herbs that support a person’s immune system in the fight against microbes include the following: American ginseng , andrographis , Asian ginseng , astragalus , coriolus, eleuthero , ligustrum , maitake , picrorhiza , reishi , schisandra , and shiitake .

1 Star
Reishi
Refer to label instructions
Reishi supports the immune system in the fight against microbes.

Herbs that support a person’s immune system in the fight against microbes include the following: American ginseng , andrographis , Asian ginseng , astragalus , coriolus, eleuthero , ligustrum , maitake , picrorhiza , reishi , schisandra , and shiitake .

1 Star
Rosemary
Refer to label instructions
Rosemary is an herb that directly attack microbes.
1 Star
Sage
Refer to label instructions
Sage is an herb that directly attack microbes.
1 Star
Sandalwood
Refer to label instructions
Sandalwood is an herb that directly attack microbes.
1 Star
Schisandra
Refer to label instructions
Schisandra supports the immune system and protects against microbes.

Herbs that support a person’s immune system in the fight against microbes include the following: American ginseng , andrographis , Asian ginseng , astragalus , coriolus, eleuthero , ligustrum , maitake , picrorhiza , reishi , schisandra , and shiitake .

1 Star
Shiitake
Refer to label instructions
Shiitake supports the immune system and protects against microbes.

Herbs that support a person’s immune system in the fight against microbes include the following: American ginseng , andrographis , Asian ginseng , astragalus , coriolus, eleuthero , ligustrum , maitake , picrorhiza , reishi , schisandra , and shiitake .

1 Star
St. John’s Wort
Refer to label instructions
St. John’s wort is an herb that directly attack microbes.

Caution: It is likely that there are many drug interactions with St. John's wort that have not yet been identified. St. John's wort stimulates a drug-metabolizing enzyme (cytochrome P450 3A4) that metabolizes at least 50% of the drugs on the market.56 Therefore, it could potentially cause a number of drug interactions that have not yet been reported. People taking any medication should consult with a doctor or pharmacist before taking St. John's wort.

Herbs that directly attack microbes include the following: chaparral , eucalyptus , garlic , green tea , lemon balm (antiviral), lomatium , myrrh , olive leaf , onion , oregano , pau d’arco (antifungal), rosemary , sage , sandalwood , St. John’s wort , tea tree oil , thyme , and usnea .
1 Star
Tea Tree
Refer to label instructions
Tea tree is an herb that directly attack microbes.
1 Star
Thyme
Refer to label instructions
Thyme is an herb that directly attack microbes.
1 Star
Usnea
Refer to label instructions
Usnea is an herb that directly attack microbes.
1 Star
Wild Indigo
Refer to label instructions
Wild indigo is both immune supportive and antimicrobial.

Herbs that support a person’s immune system in the fight against microbes and directly attack microbes include the following: barberry , echinacea , elderberry , goldenseal , licorice , Oregon grape , osha, and wild indigo .

References

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2. Nieman DC. Exercise, upper respiratory tract infection, and the immune system. Med Sci Sports Med 1994;26(2):128–39.

3. Sanchez A, Reeser JL, Lau HS, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973;26:1180–4.

4. Ahmed FE. Toxicological effects of ethanol on human health. Crit Rev Toxicol 1995;25:347–67.

5. Kubena KS, McMurray DN. Nutrition and the immune system: A review of nutrient-nutrient interactions. J Am Diet Assoc 1996;96:1156–64.

6. Horesh AJ. Allergy and infection VII. Support from the literature. J Asthma Res 1968;6:3–55 [review].

7. Pang LQ. The importance of allergy in otolaryngology. Clin Ecology 1982;1:53.

8. Nsouli TM, Nsouli SM, Linde RE, et al. Role of food allergy in serous otitis media. Ann Allergy 1994;73:215–9.

9. Horesh AJ. Allergy and recurrent urinary tract infections in childhood. II. Ann Allergy 1976;36:174–9.

10. Crandall, M. Allergic predisposition and recurrent vulvovaginal candidiasis. J Advancement Med 1991;4:21–38 [review].

11. Kudelco N. Allergy in chronic monilial vaginitis. Ann Allergy 1971;29:266–7.

12. Caceres DD, Hancke JL, Burgos RA, et al. Use of visual analogue scale measurements (VAS) to assess the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized double blind-placebo study. Phytomedicine 1999;6:217–23.

13. Hancke J, Burgos R, Caceres D, et al. A double-blind study with a new monodrug Kan Jang: decrease of symptoms and improvement in the recovery from common colds. Phytother Res 1995;9:559–62.

14. Melchior J, Palm S, Wikman G. Controlled clinical study of standardized Andrographis paniculata extract in common cold-a pilot trial. Phytomedicine 1996;34:315–18.

15. Kulichenko LL, Kireyeva LV, Malyshkina EN, Wikman GA. Randomized, controlled study of Kan Jang versus amantadine in the treatment of influenza in Volgograd. J Herb Pharmacother 2003;3:77–93.

16. Caceres DD, Hancke JL, Burgos RA, et al. Prevention of common colds with Andrographis paniculata dried extract: a pilot double blind trial. Phytomedicine 1997;4:101–104.

17. Spasov AA, Ostrovskij, OV, Chernikov MV, Wikman G. Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Phytother Res 2004;18:47–53.

18. Melchior J, Spasov AA, Ostrovskij OV, et al. Double-blind, placebo-controlled pilot and phase III study of activity of standardized Andrographis paniculata Herba Nees extract fixed combination (Kan jang) in the treatment of uncomplicated upper-respiratory tract infection. Phytomedicine 2000;7(5):341–50.

19. Gabrielian ES, Shukarian AK, Goukasova GI, et al. A double blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis. Phytomedicine 2002;9:589–97.

20. Semba RD. Vitamin A, immunity, and infection. Clin Infect Dis 1994;19:489–99 [review].

21. Glasziou PP, Mackerras DEM. Vitamin A supplementation in infectious diseases: a meta-analysis. BMJ 1993;306:366–70.

22. Stephensen CB, Franchi LM, Hernandez H, et al. Adverse effects of high-dose vitamin A supplements in children hospitalized with pneumonia. Pediatrics 1998;101(5):E3 [abstract].

23. Bresee JS, Fischer M, Dowell SF, et al. Vitamin A therapy for children with respiratory syncytial virus infection: a multicenter trial in the United States. Pediatr Infect Dis J 1996;15:777–82.

24. Quinlan KP, Hayani KC. Vitamin A and respiratory syncytial virus infection. Serum levels and supplementation trial. Arch Pediatr Adolesc Med 1996;150:25–30.

25. Kjolhede CL, Chew FJ, Gadomski AM, et al. Clinical trial of vitamin A as adjuvant treatment for lower respiratory tract infections. J Pediatr 1995;126:807–12.

26. Pinnock CB, Douglas RM, Badcock NR. Vitamin A status in children who are prone to respiratory tract infections. Aust Paediatr J 1986;22:95–9.

27. Murphy S, West KP Jr, Greenough WB 3d, et al. Impact of vitamin A supplementation on the incidence of infection in elderly nursing-home residents: a randomized controlled trial. Age Ageing 1992;21:435–9.

28. Fawzi WW, Mbise R, Spiegelman D, et al. Vitamin A supplements and diarrheal and respiratory tract infections among children in Dar es Salaam, Tanzania. J Pediatr 2000;137:660–7.

29. Ross AC. Vitamin A supplementation as therapy—are the benefits disease specific? Am J Clin Nutr 1998;68:8–9 [review].

30. Fawzi WW, Mbise RL, Fataki MR, et al. Vitamin A supplementation and severity of pneumonia in children admitted to the hospital in Dar es Salaam, Tanzania. Am J Clin Nutr 1998;68:187–92.

31. Geber WF, Lefkowitz SS, Hung CY. Effect of ascorbic acid, sodium salicylate, and caffeine on the serum interferon level in response to viral infection. Pharmacology 1975;13:228–33.

32. Hemila H. Vitamin C and the common cold. Br J Nutr 1992;67:3–16.

33. Chandra RK. Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects. Lancet 1992;340:1124–7.

34. Chavance M, Herbeth B, Lemoine A, et al. Does multivitamin supplementation prevent infections in healthy elderly subjects? A controlled trial.Int.J Vitam Nutr Res 1993;63:11–6.

35. Barringer TA, Kirk JK, Santaniello AC, et al. Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2003;138:365–71.

36. Girodon F, Lombard M, Galan P, et al. Effect of micronutrient supplementation on infection in institutionalized elderly subjects: a controlled trial. Ann Nutr Metab 1997;41:98–107.

37. Barringer TA, Kirk JK, Santaniello AC, et al. Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial. Ann Intern Med2003;138:365–71.

38. Fernandes CF, Shahani KM, Amer MA. Therapeutic role of dietary lactobacilli and lactobacillic fermented dairy products. FEMS Micro Rev 1987;343–56.

39. Mombelli B, Gismondo MR. The use of probiotics in medical practice. Int J Animicrob Agents 2000;16:531–6 [review].

40. Merenstein D, Murphy M, Fokar A, Hernandez et al. Use of a fermented dairy probiotic drink containing Lactobacillus casei (DN-114 001) to decrease the rate of illness in kids: the DRINK study. A patient-oriented, double-blind, cluster-randomized, placebo-controlled, clinical trial. Eur J Clin Nutr 2010;64:669–77.

41. Pike J, Chandra RK. Effect of vitamin and trace element supplementation on immune indices in healthy elderly. Int J Vitam Nutr Res 1995;65:117–21.

42. Chandra RK. Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects. Lancet 1992;340:1124–7.

43. Chavance M, Herbeth B, Lemoine A, et al. Does multivitamin supplementation prevent infections in healthy elderly subjects? A controlled trial. Int J Vitam Nutr Res 1993;63:11–6.

44. Girodon F, Lombard M, Galan P, et al. Effect of micronutrient supplementation on infection in institutionalized elderly subjects: a controlled trial. Ann Nutr Metab 1997;41:98–107.

45. Berger MM, Spertini F, Shenkin A, et al. Trace element supplementation modulates pulmonary infection rates after major burns: a double-blind, placebo-controlled trial. Am J Clin Nutr 1998;68:365–71.

46. Fraker PJ, Gershwin ME, Good RA, Prasad A. Interrelationships between zinc and immune function. Fed Proc 1986;45:1474–9.

47. Prasad AS, Beck FWJ, Bao B, et al. Zinc supplementation decreases incidence of infections in the elderly: effect of zinc on generation of cytokines and oxidative stress. Am J Clin Nutr 2007;85:837–44.

48. Caceres DD, Hancke JL, Burgos RA, et al. Use of visual analogue scale measurements (VAS) to assess the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized double blind-placebo study. Phytomedicine 1999;6:217–23.

49. Hancke J, Burgos R, Caceres D, et al. A double-blind study with a new monodrug Kan Jang: decrease of symptoms and improvement in the recovery from common colds. Phytother Res 1995;9:559–62.

50. Melchior J, Palm S, Wikman G. Controlled clinical study of standardized Andrographis paniculata extract in common cold-a pilot trial. Phytomedicine 1996;34:315–18.

51. Kulichenko LL, Kireyeva LV, Malyshkina EN, Wikman GA. Randomized, controlled study of Kan Jang versus amantadine in the treatment of influenza in Volgograd. J Herb Pharmacother 2003;3:77–93.

52. Caceres DD, Hancke JL, Burgos RA, et al. Prevention of common colds with Andrographis paniculata dried extract: a pilot double blind trial. Phytomedicine 1997;4:101–104.

53. Spasov AA, Ostrovskij, OV, Chernikov MV, Wikman G. Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Phytother Res 2004;18:47–53.

54. Melchior J, Spasov AA, Ostrovskij OV, et al. Double-blind, placebo-controlled pilot and phase III study of activity of standardized Andrographis paniculata Herba Nees extract fixed combination (Kan jang) in the treatment of uncomplicated upper-respiratory tract infection. Phytomedicine 2000;7(5):341–50.

55. Gabrielian ES, Shukarian AK, Goukasova GI, et al. A double blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis. Phytomedicine 2002;9:589–97.

56. Markowitz JS, Donovan JL, DeVane CL, et al. Effect of St John's wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA 2003;290:1500–4.

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