Background: The efficacy of many preparations for topical use in herpes infections have remained rather disappointing. The development of new antiviral drugs, especially herbal preparations, thus remains desirable. In a screening study with plant extracts, a rhubarb root extract and a sage extract showed a promising activity. Objective: The efficacy of a combined topical preparation with rhubarb and sage extracts, of a singleagent preparation with sage extract and of a reference treatment was investigated in a double-blind, comparative, randomised trial. Patients and Methods: A total of 149 patients participated, and 145 patients (111 female, 34 male) of whom 64 received the rhubarb-sage cream, 40 the sage cream and 41 Zovirax cream could be evaluated by intention-to-treat analysis. The dried rhubarb extract (23 mg/g) is a standardised aqueous- ethanolic extract according to the German Pharmacopoeia (DAB) with 4.0–6.0% hydroxyanthracene derivatives. The dried sage extract (23 mg/g) is an aqueous extract. The reference product was Zovirax cream (Zovirax® Creme) with the active ingredient aciclovir (50 mg/g). Results: The mean time to healing in all cured patients was 7.6 days with the sage cream, 6.7 days with the rhubarb-sage cream and 6.5 days with Zovirax cream. There were statistically significant differences in the course of the symptoms. For the parameter ‘swelling’, at the 1st followup visit there was a significant advantage for Zovirax cream compared to sage cream, and for the parameter ‘pain’, at the 2nd follow-up visit there was a significant difference in favour of the rhubarb-sage cream compared to the sage cream. Conclusion: The combined topical sage-rhubarb preparation proved to be as effective as topical aciclovir cream and tended to be more active than the sage cream.

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