[Phytotherapy in the German Medical AWMF S3 guidelines - a systematic overview]

In Germany, the interdisciplinary, evidence- and consensus-based medical AWMF S3 guidelines represent the highest available scientific level and have significant impact on patient care. In Germany, Austria, and Switzerland, herbal medicine has a long tradition in medical care. Of notice, the evidence for its efficacy in numerous indications is increasing. This systematic review evaluates to which extent phytotherapy is taken into account in the current S3 guidelines. In all available medical AWMF S3 guidelines, the recommendations/statements on phytotherapeutic options were identified, and 2 independent experts classified them into 3 categories: positive, negative, and open. In addition, comments on side effects and interactions were extracted. Phytotherapeutic options are specified in 40 (31.3 %) out of 128 AWMF S3 guidelines. Phytotherapy was not included in 55 guidelines (42.9%) with potential herbal therapeutic options. From 204 recommendations 139 (68.1%) are negative or remain open. In 27 guidelines (67.5%) phytotherapy is listed in the chapter for complementary and alternative medicine and/or miscellaneous, in 7 guidelines (17.5%) it is mentioned at the end of the recommendations on medical drug therapy, and in 8 guidelines (20.0%) it is listed in the recommendations regarding conventional treatments. Side effects and interactions are stated in 70 out of 204 recommendations (34.3%). Less than half of the currently available medical AWMF S3 guidelines include phytotherapy in their search strategy. Only few positive statements and recommendations on herbal medicine are taken into account. A systematic and comprehensive work up of the existing evidence on the one hand and the consequent incorporation on the other is necessary to appropriately integrate phytotherapy in the German medical guidelines.