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Garlic oil is effective against numerous bacteria, viruses and fungi including Staphylococcus aureus, MRSA, and several species of Candida, Aspergillus and Cryptococcus neoformans in vitro (Davis et al 1994, Tsao & Yin 2001, Yoshida et al 1987). As such, it has been used both internally and externally to treat various infections and prevent wound infection.

Tinea pedis, tinea corporis, tinea cruris A trial comparing the effects of three different strengths of ajoene cream (0.4%, 0.6% and 1 %) with 1 % terbinafine applied twice daily found the cure rate to be 72% for 0.6% ajoene, 100% for 1% ajoene, and 94% for 1% terbinafine after 60 days (Ledezma et al 2000). Vaginitis Taken internally as a 'natural antibiotic' or applied topically in a cream base, garlic is used to treat vaginitis. The considerable antibacterial activity of garlic provides a theoretical basis for its use in this condition, but controlled studies are not available to determine effectiveness.

Common cold prevention A 12-week, double-blind randomised study involving 146 people demonstrated that allicin-containing garlic preparations significantly reduce the incidence of colds and accelerate recovery compared with placebo (Josling 2001). More specifically, the number of symptom days in the placebo group was 5.01 compared with 1.52 days in the garlic treated group. Additionally, garlic reduced the incidence of developing a second cold whereas placebo did not. Helicobacter pylori infection It has been suggested that gastrointestinal lesions, such as gastric ulcers, duodenal ulcers and gastric cancers, are strongly associated with H. pylori infection (Scheiman & Cutler 1999). Medical treatment consisting of 'triple therapy' has a high eradication rate, yet is associated with side-effects and has started to give rise to antibiotic resistance. Since garlic intake has been associated with a lowered incidence of stomach cancer, researchers have started investigating whether garlic has activity against H. pylori. Several in vitro and in vivo tests have shown garlic to be effective against H. pylori (see MAIN ACTIONS). However, to date only a few small clinical trials have been conducted with disappointing and controversial results (Aydin et al 2000, Graham et al 1999, McNulty et al 2001).

A small pilot study of dyspeptic patients with confirmed H. pylori infection found that treatment with 4 mg garlic oil capsules taken four times daily with meals for 14 days did not alter symptoms or lead to H. py/ori eradication (McNulty et al 2001). Another small study using garlic oil 275 mg three times a day (allicin 800 ^g/capsule) either as stand-alone treatment or in combination with omeprazole (20 mg twice © 2007 Elsevier Australia

daily) found that both treatments produced similar results (Aydin et al 2000). These results were confirmed in another small clinical study (Graham et al 1999).

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