Homeopathy for tonsillitis: A systematic review

Introduction
Tonsillitis is a common condition predominantly affecting children and adolescents, presenting as acute, recurrent, or chronic infection. This review evaluated the effectiveness of homeopathy for clinical improvement and recurrence prevention across all tonsillitis presentations.

Methods
We searched nine databases and four trial registries for randomised controlled trials (RCTs) and non-randomised controlled trials (nRCTs) involving patients of all ages with diagnosed tonsillitis. Studies examining individualised homeopathy (IH) and non-individualised homeopathy (non-IH) were included, compared with an inactive or active control group. Primary outcomes were clinical improvement (symptoms and signs) and recurrence. Secondary outcomes were antibiotic consumption, healthcare utilisation, quality of life, costs, and adverse events. Data extraction, Risk of Bias assessment, and certainty of evidence evaluation (GRADE) followed established methodology.

Results
Five RCTs compared homeopathy with placebo (n=4) or standard care (n=1): one used IH, one used both IH and non-IH, and three used non-IH. Two RCTs examined acute tonsillitis, two examined recurrent tonsillitis, and one examined chronic tonsillitis. Three trials enrolled children, one enrolled adults, and one enrolled a mixed population. Sample sizes ranged from 30 to 256. Substantial heterogeneity across populations, interventions, and outcomes precluded meta-analysis. Individual RCTs showed that in acute tonsillitis, non-IH achieved short-term symptom improvement. In recurrent tonsillitis, both IH and non-IH were associated reduced infection recurrence, lower antibiotic consumption, and improved quality of life, with the strongest evidence for a standardised non-IH complex (SilAtro-5-90). In chronic tonsillitis, IH showed delayed but consistent improvements in symptoms, recurrence, healthcare utilisation, and quality of life by 2–3 months, with early outcomes favouring placebo. The certainty of evidence for all outcomes was low. No serious adverse events were reported.

Conclusion
Evidence from individual trials suggests that both individualised and non-individualised homeopathy may benefit clinical improvement, reduce infection recurrence, reduce antibiotic use, and enhance quality of life in tonsillitis, with no safety concerns reported. However, substantial heterogeneity across studies and methodological limitations restrict the ability to draw definitive conclusions about homeopathy's effectiveness in patients with tonsillitis. Further well-designed, adequately-powered trials with standardised outcomes and consistent methodological approaches are needed to strengthen the evidence base and enable more robust conclusions.