Xyloglucan, Hibiscus and Propolis in the Management of Uncomplicated Lower Urinary Tract Infections: A Systematic Review and Meta-Analysis

Cai, Tommaso; Anceschi, Umberto; Tamanini, Irene; Migno, Serena; Rizzo, Michele; Liguori, Giovanni; García-Larrosa, Alejandro; Palmieri, Alessandro; Verze, Paolo; Mirone, Vincenzo; Johansen, Truls E. Bjerklund

doi:10.3390/antibiotics11010014

Cited by 7 publications

(5 citation statements)

References 23 publications

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“…In a review and meta-analysis, Cai et al found a statistically significant difference in UTI clinical or microbiological resolution between the use of the medical device and the comparator (three randomized clinical trials; 178 patients; OR: 0.13; 95% CI: 0.05–0.33; p < 0.0001). Moreover, no clinically significant adverse effects were reported in their studies [ 28 ]. In an observational prospective study by Cai et al [ 18 ], 61 women with recurrent UTIs were given the medical device for six months.…”

Section: Discussionmentioning

confidence: 99%

Cystitis and Utipro® Plus: Real-World Evidence

Kostev,

Cai

2023

Healthcare

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Background: The emergence of drug resistance in the etiological agents of uncomplicated urinary tract infections (UTIs) emphasizes the need to shift the paradigm towards alternative therapeutic strategies. The objective of the present study was to evaluate the use of a medical device containing xyloglucan, hibiscus, and propolis for reducing UTI symptomatic episodes, antibiotic prescription, and days of sick leave. Materials and Methods: It used retrospective, cross-sectional study data provided by office-based physicians from Germany (Disease Analyzer, IQVIA database), including those on 3586 patients with a diagnosis of UTI treated with Utipro® Plus (Noventure, Barcelona, Spain) from January 2015 to December 2020. Results: The majority of patients were women (94.2%) and had a mean age (standard deviation, SD) of 57.7 years (19.0). Within 12 months after the prescription and compared to the 12 months before, it was observed that there was a reduction in the proportion of patients with at least one UTI diagnosis (from 79.4% to 36.4%, p < 0.001), in antibiotic prescriptions (from 33.5% to 22.1%, p < 0.001), and in the proportion of patients with at least one day of sick leave (from 4.1% to 2.7%). Conclusions: The use of Utipro® Plus is able to decrease UTI recurrence and can lead to the reduction of antibiotic prescriptions and disease burden in individuals affected by uncomplicated cystitis.

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Section: Discussionmentioning

confidence: 99%

Cystitis and Utipro® Plus: Real-World Evidence

Kostev,

Cai

2023

Healthcare

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“…Consequently, hibiscus and propolis might exert a beneficial effect at the urinary level, while XG might provide a protective barrier against bacteria in the intestinal tract [113]. More recently, the reported data have been re-evaluated, confirming that the product that combines XG, hibiscus and propolis has superior effectivity in adult women with uncomplicated cystitis [114].…”

Section: Mucosal Protectantmentioning

confidence: 91%

A Review of Xyloglucan: Self-Aggregation, Hydrogel Formation, Mucoadhesion and Uses in Medical Devices

Esquena

2022

Macromol

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The present paper reviews the self-aggregation, gel-forming and adsorption properties of xyloglucan (XG), and its main applications as a medical device for wound dressings, mucosal protection and ocular lubrication, as well as its uses as an excipient. XG is a branched polysaccharide composed of a central backbone of D-glucose units linked by β(1→4)-glycosidic bonds, decorated with D-xylose units through α(1→6) glycosidic bonds, and with some D-galactose units anchored to these D-xylose units via β(1→2) bonds. XG forms self-aggregates with a hierarchically ordered morphology in aqueous solutions, leading to the formation of nanofibers. Consequently, XG is a hydrogel-forming polymer able to retain large amounts of water. Inside the human digestive tract, XG is enzymatically degalactosylated, but the backbone with xylose side chains remains stable until excretion. Degalactosylated XG undergoes a fully reversible sol–gel transition, forming hydrogels between upper and lower critical temperatures. XG adsorbs on intestinal mucosa and creates a diffusion barrier that reduces permeability and also prevents bacterial infections by reducing their infiltration. Therefore, orally administered XG is considered a mucosa protectant.

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“…XHP (Xyloglucan, Hibiscus, and Propolis) XHP (xyloglucan, hibiscus, and propolis) is a medical technology product containing, in its form marketed in Greece, 100 mg of each of the three ingredients. It has been shown to have positive effects in a randomized controlled trial for the treatment of lower UTIs but as an adjuvant to antibiotic treatment [38,39].…”

Section: Arctostaphylos Uva-ursi Extractmentioning

confidence: 99%

Lower Urinary Tract Infections: An Approach for Greek Community Health Practitioners

Klimentidis,

Pappas

2024

Acta Microbiologica Hellenica

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Urinary tract infections (UTIs) cause a significant infectious burden in the community and demand a coordinated approach from all first-line health professionals. Uncomplicated UTIs refer to infections in non-pregnant females without any underlying localized or generalized pathology, diagnosed through history by the presence of specific local symptoms and in the absence of systemic ones like fever. Uncomplicated UTIs are usually caused by Escherichia coli species; thus, empirical antibiotic treatment can be immediately initiated. A percentage of patients can experience a resolution of symptoms without therapy; however, this “wait and observe” approach is supported only by the relevant British guidelines. There are limited quality studies in the literature on adjuvant treatment options; these can include BNO 145, a phytotherapeutic medicine, and XHP, a medical technology product. Despite being licensed by the European Medicines Agency on the basis of traditional use, there is inadequate support in the medical literature for the use of cranberry extracts and Arctostaphylos uva-ursi extracts. The use of antibiotics is associated with higher response rates and urine culture sterilization as well as lower recurrence/relapse rates; on the other hand, side effect rates are also higher. In choosing the proper empirical antibiotic therapy, one has to take into account individual patient characteristics and community resistance patterns as well as the antimicrobial resistance pressure exerted by the wide use of a specific antibiotic. There is a need for a common framework through which all frontline health practitioners should operate when faced with a case of uncomplicated UTI. In Greece, there are three different guidelines for UTI treatment, developed by the Ministry of Health, the National Organization for Medicines, and the Hellenic Society for Infectious Diseases. The authors of the present study aim at synthesizing these guidelines as well as relevant guidelines from international scientific or other national regulatory organizations while taking into account local resistance patterns. The authors propose the first-line use of either fosfomycin, nitrofurantoin, or pivmecillinam. The use of trimethoprim/sulfamethoxazole is discouraged due to increased resistance of Greek community E. coli isolates. Fluoroquinolone use should be avoided due to high E. coli community resistance (exceeding 20% for Greece), along with their unfavorable benefit/side effect balance in uncomplicated UTIs, as well as the overall community resistance pressure exerted by their use. A 5-day regimen remains superior to a 3-day one; the latter may be suitable for certain, not yet adequately characterized, patients.

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Xyloglucan, Hibiscus and Propolis in the Management of Uncomplicated Lower Urinary Tract Infections: A Systematic Review and Meta-Analysis

Cited by 7 publications

References 23 publications

Cystitis and Utipro® Plus: Real-World Evidence

Cystitis and Utipro® Plus: Real-World Evidence

A Review of Xyloglucan: Self-Aggregation, Hydrogel Formation, Mucoadhesion and Uses in Medical Devices

Lower Urinary Tract Infections: An Approach for Greek Community Health Practitioners

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