title: Systematic review of clinical data with BNO-101 (Sinupret) in the treatment of sinusitis.
abstract: BACKGROUND
  The herbal formula BNO-101 (containing Gentianae radix, Primulae flos, Rumicis herba, Sambuci flos and Verbenae herba; ratio 1:3:3:3:3) has been widely employed as a 'mucoactive' agent in Germany for 70 years for the symptoms of respiratory infections. This paper reviews the clinical evidence of BNO-101 in sinusitis.
  
  
  METHODS
  The systematic search identified 22 studies with BNO-101. Out of these, 6 controlled trials on sinusitis were reassessed according to predefined criteria. 4 trials had almost identical designs and could be examined by meta-analysis.
  
  
  RESULTS
  The database comprised approximately 900 patients, mostly young adult males. After 2 weeks of treatment, verum was significantly superior to placebo (2 RCTs, 159 vs. 160 patients, both add-on to antibacterial treatment). The benefit regards the patients' assessment ('cured': verum = 61.1%, placebo = 34.5%), reduction of drain obstruction, headache and radiological signs (all p < 0.05). Comparing BNO-101 to ambroxol (2 RCTs, 151 vs. 150 patients, add-on to antibacterials in 13% of the cases) the patients' assessment after 2 weeks showed no difference, although it favoured BNO-101 in chronic cases ('cured' BNO-101 = 37.1%, ambroxol = 12.5%; p < 0.05). It also favoured BNO-101 concerning pyorrhoea and headache (p < 0.05). No significant differences were reported in 2 open randomised trials vs. N-acetyl-cysteine and vs. the herbal product Myrtol std.
  
  
  CONCLUSIONS
  BNO-101, combined with standard antibacterial therapy, significantly reduces the acute symptoms and signs of sinusitis. The effects are of the same order of magnitude as observed with other mucoactive agents. In the trials investigated BNO-101 had a favourable risk/benefit ratio, with an incidence of adverse events similar to placebo.
authors.affiliation: Institute of Complementary Medicine, Department of Internal Medicine, University Hospital, Zurich, Switzerland. joerg.melzer@usz.ch
authors.forename: Jörg
authors.initials: J
authors.lastname: Melzer
authors.forename: Reinhard
authors.initials: R
authors.lastname: Saller
authors.forename: Andreas
authors.initials: A
authors.lastname: Schapowal
authors.forename: Reto
authors.initials: R
authors.lastname: Brignoli
mesh_terms: D001294:Attitude to Health; D000529:Complementary Therapies; D018849:Controlled Clinical Trials as Topic; D003430:Cross-Sectional Studies; D005194:Family Practice; D006801:Humans; D010821:Physicians, Family; D008517:Phytotherapy; D010936:Plant Extracts / Q000627:therapeutic use*; D012852:Sinusitis / Q000628:therapy*; D011795:Surveys and Questionnaires; D013557:Switzerland
chemical_list: D010936:Plant Extracts; C028353:Sinupret