Prevention and treatment of uncomplicated lower urinary tract infections in the era of increasing antimicrobial resistance—non-antibiotic approaches: a systemic review

Abstract

PurposeUrinary tract infections (UTIs) are one of the more common infections encountered in everyday clinical practice. They account for 10–20% of all infections treated in primary care units and 30–40% of those treated in hospitals. The risk of UTI in the female population is considered to be 14 times higher than in the male population. The prevalence of bacterial etiology results in a large consumption of broad-spectrum antibiotics, which in turn leads to increased rates of resistant uropathogens. Therefore, non-antibiotic prevention and treatment options are now of great importance.MethodsA systematic literature search was performed for the last 20 years (1999–2019) and the efficiencies of these eight different non-antibiotic interventions were analysed and discussed.ResultsThis article provides an overview on non-antibiotic options for management of UTI, including the application of cranberry products, the phytodrug Canephron N, probiotics, nonsteroidal anti-inflammatory drugs (NSAID), d-mannose, estrogens, vitamins, and immunotherapy.ConclusionsThe last 20 years of research on non-antibiotic approaches in UTI have not brought conclusive evidence that antibiotic usage can be replaced completely by non-antibiotic options. Hence, antibiotics still remain a gold standard for UTI treatment and prevention. However, changing the therapeutic strategy by including non-antibiotic measures in the management of UTI could be successful in avoiding antimicrobial resistance at least to some extent.

Oligosaccharides and Complex Carbohydrates: A New Paradigm for Cranberry Bioactivity

“…Perhaps the best known benefit of cranberry consumption is the promotion of urinary tract (UT) health, but with each new systematic review of the clinical literature the recommendation seems to change regarding whether the use of cranberry products for the prevention of UTIs is scientifically supported [18][19][20][21][22][23]. Much of this controversy may arise from limited characterization of the cranberry materials used, a lack of understanding of the cranberry constituents that directly impact UT health, and a lack of awareness of the role of the UT microbiota in overall health and disease prevention.…”

“…This new recognition of the UT microbiota and its significance for UT health versus disease indicates that studies intending to investigate the ability of cranberry materials to prevent UTIs may actually have been unknowingly investigating the effects of cranberry consumption on UT microbiota populations. This perspective, when combined with diverse host factors and a limited understanding of cranberry material chemistry, readily explains the high degree of inter-individual variability in response to cranberry product administration [4,73,208,213] and the resulting controversy over cranberry clinical trial results [19][20][21][22][23]. To further add to this, the composition and solute concentration of urine is highly dynamic in response to overall health and diet [185], and may be further influenced by the metabolism of UT microbiota populations.…”

“…The conventional clinical paradigm regarding the use of cranberry materials for UTI prevention is based on the presence of components in human urine as a result of cranberry consumption that prevent infection by preventing E. coli adhesion to uroepithelial cells [4,23,313]. The compounds most often cited as being responsible for the observed anti-adhesive properties of urine are PACs [314] in spite of the current understanding that these compounds are unlikely to be directly excreted into human urine at significant concentrations, if at all [315].…”

Predicting the use of antibiotics after initial symptomatic treatment of an uncomplicated urinary tract infection: analyses performed after a randomised controlled trial

“…28 A systematic review conducted by Wawrysiuk et al concludes that using shared decision-making and delayed prescribing with advice to take NSAIDs for symptom relief can be a preferred strategy for patients with uncomplicated UTIs, but the patient should receive close follow-up. 29 Given the current knowledge, recommending symptomatic relief to patients who are willing to delay taking antibiotics, with a backup prescription at hand, seems to be a safe and efficient strategy to lower antibiotic prescribing for women with uncomplicated UTIs.…”

Preclinical Evaluation of Pharmaceutical Compositions and Their Components for Urinary Health

“…Urinary tract infections are among the commonest of primary care issues accounting for millions of physician visits annually, and can range from asymptomatic to acute and may extend upward to involve the kidneys and spread beyond leading to sepsis and death in compromised individuals. Antibiotic treatment is standard but challenges and opportunities remain for progress in dealing with this prevalent medical problem including dosing or alternatives [1]. Antimicrobial pharmaceuticals may be limited either by antibiotic resistance or may select for antibiotic resistant strains.…”