Acute pharyngotonsillitis (APT) is one of the most common upper respiratory tract infections encountered in primary care and is a frequent cause of sore throat, dysphagia, and physician visits. Although the majority of cases are viral in origin—estimated at 70–95% depending on age—antibiotics are still widely prescribed despite guidelines recommending their use only for confirmed or strongly suspected bacterial infections. This pattern contributes to unnecessary antibiotic exposure and increasing antimicrobial resistance.
A new real-world observational study published in Otorhinolaryngology evaluated whether oral essential oil therapy (OEOT) could provide a safe and effective alternative for symptom management in patients with mild-to-moderate APT treated in primary care settings. The study compared an essential oil formulation with standard antibiotic therapy to assess symptom relief, tolerability, and potential antibiotic avoidance.
Study Design and Methods
This retrospective observational study included 97 adult patients with clinically diagnosed acute pharyngotonsillitis treated by seven general practitioners in Spain during the autumn–spring respiratory infection season of 2023–2024. Patients were evaluated in clinical visits and monitored daily using telemedicine tools such as WhatsApp, SMS, or email to report symptom progression.
Participants were divided into three treatment groups:
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Group A: Oral Penicillin V (500 mg twice daily for 10 days)
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Group B: Oral essential oil therapy (OEOT) at standard dose (1 capsule three times daily for 5 days)
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Group C: OEOT at double dose (2 capsules three times daily for 5 days)
The OEOT product (Oleobiotic Salud Respiratoria) contained five essential oils:
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Origanum vulgare (oregano) – 135 mg
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Eucalyptus species – 120 mg
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Cinnamomum cassia (cinnamon) – 90 mg
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Pinus sylvestris (Scots pine) – 60 mg
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Citrus limon (lemon peel) – 45 mg
Patients tracked daily outcomes for 10 days, including:
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Sore throat severity using a visual analog scale (VAS)
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Overall perception of health status
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Body temperature
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Patient and physician satisfaction
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Adverse events
The primary outcome was improvement in clinical symptoms, while secondary outcomes included symptom duration, tolerability, and the potential reduction in antibiotic use.
Key Findings
Across all three treatment groups, patients experienced significant improvements in symptoms over time.
Sore throat relief
All groups showed a steady reduction in sore throat severity measured by VAS. Statistically significant improvements occurred at days 3, 5, and 10 (P < 0.001). After just three days of treatment:
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100% of antibiotic patients improved
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88% of standard-dose OEOT patients improved
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91% of high-dose OEOT patients improved
Overall health status
Patients in each group also reported improved overall well-being during the treatment period. By day three:
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100% of antibiotic patients reported improvement
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91% of standard-dose OEOT patients improved
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82% of double-dose OEOT patients improved
Body temperature
Body temperature decreased significantly over time in all groups. Most participants did not have high fever at baseline, but mild temperature elevations declined during treatment in all cohorts.
Safety and tolerability
Adverse events were reported in 10 patients overall, distributed across treatment groups. These included mild gastrointestinal symptoms such as dyspepsia, diarrhea, nausea, or reflux. All adverse effects were mild and resolved without intervention.
Patient and physician satisfaction
Both patients and physicians reported high satisfaction levels with treatment outcomes. Notably, 89% of patients using essential oil therapy indicated they would use the treatment again for future episodes of pharyngotonsillitis.
Antibiotic avoidance
Physicians estimated that essential oil therapy allowed antibiotic avoidance in approximately 85–88% of cases treated with OEOT.
Proposed Mechanisms
The observed benefits may be related to the biological properties of the essential oils used in the formulation. Essential oils are complex plant-derived compounds containing phenols, terpenes, aldehydes, and other bioactive molecules known for antimicrobial, anti-inflammatory, antiviral, and immunomodulatory effects.
Several of the included oils have documented pharmacological activity:
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Oregano oil exhibits antibacterial and antioxidant properties.
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Eucalyptus oil demonstrates antimicrobial and anti-inflammatory activity.
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Lemon oil may help reduce viral respiratory symptoms.
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Cinnamon oil has antimicrobial effects.
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Scots pine oil shows anti-inflammatory and bactericidal activity.
These combined actions may contribute to reduced throat inflammation, improved respiratory symptoms, and faster symptom resolution.
Study Limitations
The authors note several limitations, including:
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Open-label design
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Lack of placebo control
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Absence of microbiological confirmation of infection
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No biomarker evaluation
However, the study reflects real-world primary care practice, making the findings potentially applicable to routine clinical management of mild pharyngotonsillitis.
Clinical Implications
The findings suggest that a five-day course of oral essential oil therapy may provide symptom relief comparable to antibiotic therapy for uncomplicated APT, while potentially reducing unnecessary antibiotic prescriptions. Given the growing emphasis on antibiotic stewardship, OEOT may represent a promising complementary option for managing mild respiratory infections in primary care.
