Novel Strategies in the Prevention and Treatment of Urinary Tract Infections

Abstract

Urinary tract infections are one of the most common bacterial infections, especially in women and children, frequently treated with antibiotics. The alarming increase in antibiotic resistance is a global threat to future treatment of infections. Therefore, alternative strategies are urgently needed. The innate immune system plays a fundamental role in protecting the urinary tract from infections. Antimicrobial peptides form an important part of the innate immunity. They are produced by epithelial cells and neutrophils and defend the urinary tract against invading bacteria. Since efficient resistance mechanisms have not evolved among bacterial pathogens, much effort has been put into exploring the role of antimicrobial peptides and possibilities to utilize them in clinical practice. Here, we describe the impact of antimicrobial peptides in the urinary tract and ways to enhance the production by hormones like vitamin D and estrogen. We also discuss the potential of medicinal herbs to be used in the prophylaxis and the treatment of urinary tract infections.

The role of nutraceuticals and phytotherapy in the management of urinary tract infections: What we need to know?

“…The main arguments for using a non-antibiotic approach to prevent recurrence among UTI patients are as follows: The use of antibiotic prophylaxis for recurrent UTI is not generally accepted; the risk of bacterial resistance is already high and still increasing; the tolerability and the compliance to nonantibiotic products is high; preliminary study findings are promising. While long-term antibiotic prophylaxis might efficiently inhibit new intravesical bacterial growth during the treatment period, infections are likely to reccur when the prophylactic treatment ends (37)(38).…”

“…-E. coli is able to adhere to the bladder epithelium, invade the cells and form intracellular bacterial communities, which can remain quiescent reservoirs able to cause new recurrences when reactivated (38).…”

“…However, possible reasons for the inefficacy of cranberry extracts found in the cited RCTs should also be taken into account. Firstly, multi-step processing of cranberry production leads to a substantial loss of phytochemicals (through elimination of rich fractions like skin and seeds), which are further damaged by thermal degradation, as well as oxidation by polyphenol oxidase and peroxidase (38). Moreover, the exact concentration of active metabolites on the action site and the pharmacokinetics of cranberry extracts is unknown.…”

Prospective Observational Cohort Study of the Efficacy of Bacterial Immune Prophylaxis in the Prevention of Uncomplicated, Recurrent Urinary Tract Infections

“…This alarming increase in bacterial resistance to antibiotics is a global threat to the future treatment of infections and has created the need to develop alternative models of prevention and treatment for UTI, including vaccines [8][9][10].…”

Prospective study to compare antibiosis versus the association of N-acetylcysteine, D-mannose and Morinda citrifolia fruit extract in preventing urinary tract infections in patients submitted to urodynamic investigation

“…UTIs represent a great problem for the public health systems, because they are responsible for high morbility and are also one of the main causes of antibiotic prescriptions associated to an increased resistance to them (1). In Europe UTIs represent the second cause of bacterial infection, after the respiratory, and are the most frequent form of nosocomial infections, associated mostly to the bladder catheterism (2,3).…”