Effect of Andrographis paniculata Treatment for Nonimmune Patients with Early-Stage COVID-19 on the Prevention of Pneumonia: A Retrospective Cohort Study

Author(s): Amporn Benjaponpitak, Thiti Sawaengtham, Tewan Thaneerat, Kulthanit Wanaratna, Palang Chotsiri, Chalermquan Rungsawang, Sakkarin Bhubhanil, Sataporn Charoensuk, Suwat Benjaponpitak, Sarawut Lapmanee, Sayomporn Sirinavin


Andrographis paniculata (AP) is an herbal plant that has been used to treat upper respiratory tract infections. Andrographolide is the major active component of AP that inhibits intracellular SARS-CoV-2 replication and has anti-inflammatory action.


To investigate the therapeutic and adverse effects of treatment with oral AP-products in patients with early-stage COVID-19.


We performed a retrospective cohort study in COVID-19 patients with asymptomatic or mild COVID-19, admitted for isolation and treatment in seven hospitals in three adjacent provinces in central region of Thailand, during December 2020 – March 2021 epidemic when COVID-19 vaccine was not yet available and none were previously infected with SARS-CoV-2. Patient data was prospectively recorded in the structured medical record forms and retrospectively reviewed. This study included patients 15 to 60 years of age with laboratory-confirmed SARS-CoV-2 infection, but without comorbidities or pregnancy. Study AP products were capsules containing a standardised ethanol extract of AP or crude AP powder. Patients were treated for five days with either AP-extract (60 mg andrographolide, 3 times daily) or crude-AP (48 mg andrographolide, 3 times daily), only when available. All eligible patients who received AP treatment were included and control patients who did not receive AP treatment were blindly and randomly selected using a ratio of approximately 1:1. The risk of pneumonia diagnosed by chest radiography was the primary study outcome.


About 90% of the treatment group received the AP-extract regimen within 7 days after onset of symptoms. Pneumonia occurred in 1/243 AP treatment patients and 69/285 control patients. The risks of pneumonia after adjusting for confounding effects were 0.3% (95%CI, 0%-0.9%) and 24.3% (95%CI, 19.0%-29.7%) in the AP treatment and control groups, respectively. The number needed to treat to avoid pneumonia development in one patient was four (95% CI, 3-5). Mild abnormal symptoms suggesting adverse event of AP treatment were detected in eight patients.


The oral AP-extract treatment regimen is acceptably safe and associated with highly reduced rates of pneumonia in nonimmune patients with early-stage COVID-19.

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