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

Abstract

Background: The abuse of antimicrobical drugs has increased the resistance of microorganisms to treatments, thus to make urinary tract infections (UTIs) more difficult to eradicate. Among natural substances used to prevent UTI, literature has provided preliminary data of the beneficial effects of D-mannose, N-acetylcysteine, and Morinda citrifolia fruit extract, due to their complementary mechanism of action which contributes respectively to limit bacteria adhesion to the urothelium, to destroy bacterial pathogenic biofilm, and to the anti-inflammatory and analgesic activity. The purpose of this study was to compare the administration of an association of D-mannose, N-acetylcysteine (NAC) and Morinda citrifolia extract versus antibiotic therapy in the prophylaxis of UTIs potentially associated with urological mini-invasive diagnostics procedures, in clinical model of the urodynamic investigation. Methods: 80 patients eligible for urodynamic examination, 42 men and 38 women, have been prospectively enrolled in the study and randomised in two groups (A and B) of 40 individuals. Patients of group A followed antibiotic therapy with Prulifloxacine, by mouth 400 mg/day for 5 days, while patients of the group B followed the association of mannose and NAC therapy, two vials/day for 7 days. Ten days after the urodynamic study, the patients were submitted to urine examination and urine culture. Results: The follow up assessment didn't show statistical significant difference between the two groups regarding the incidence of UTI. Conclusions: The association of mannose and NAC therapy resulted similar to the antibiotic therapy in preventing UTIs in patients submitted to urodynamic examination. This result leads to consider the possible use of these nutraceutical agents as a good alternative in the prophylaxis of the UTI afterwards urological procedures in urodynamics.

Antibiotic prophylaxis for urodynamic testing in women: a systematic review

“…The study critically appraised as least likely biased showed a statistically significant effect of antibiotic prophylaxis in reducing bacteriuria following UDS [14], but it was not powered to show a significant change in incidence of UTI after UDS and thus it did not demonstrate an effect of antibiotic prophylaxis on UTI incidence after UDS in female patients [14]. The other two reviewed studies showed neither an effect of antibiotic prophylaxis on bacteriuria or UTI incidence in women undergoing UDS [15,16].…”

“…Of course, other considerations to decrease the risk of infection associated with catheterization are already being explored in the form of protein, silver and nitrazine coating of catheters, surface micropatterns on catheters and variable preprocedural meatal cleaning [21][22][23][24][25][26]. In addition, alternative UTI prophylaxis with cranberry juice, cranberry extract, Nacetylcysteine and lactobacilli is also an emerging field of research to consider in this ongoing debate [15,16,[27][28][29][30][31][32][33].…”

“…1 PRISMA diagram: Flow of literature through the search and appraisal process trials were excluded from the review, one because the author did not respond to the request for female-specific data and the other because the author replied to the request for femalespecific data, but data provided were incongruent with published results. Three randomized controlled trials involving 325 patients in total were included in this review [14][15][16]. An overview of these studies can be found in Table 1.…”

Expand+In Vivoiv.iiarjournals.orgIn Vivo September-October 2017 vol. 31 no. 5 931-936 Efficacy of N-acetylcysteine, D-mannose and Morinda citrifolia to Treat Recurrent Cystitis in Breast Cancer Survivals

“…In order to minimize the chronicity of an infection and improving the efficacy of antibiotics, the current prophylaxis in uroginecology has been previously demonstrated by urodynamic and is based on Dmannose, N-acetylcysteine (NAC) and Morinda citrifolia fruit extract (NDM) with antibacterial, anti-inflammatory, analgesic and immunomodulatory activity (7). D-Mannose has a binding affinity to the E. coli surface adhesins in order to reduce the adhesion between the bacteria and urothelium (8,9).…”

“…D-Mannose has a binding affinity to the E. coli surface adhesins in order to reduce the adhesion between the bacteria and urothelium (8,9). NAC has the ability to disrupt the pathogen polymicrobial biofilm and Morinda citrifolia fruit extract is a natural strong antiinflammatory, immunostimulating, antimicrobial and cancer chemopreventive phytotherapeutic product (7,(10)(11)(12). In particular, literature has shown an increase in the efficacy of phosphomycin, nitrofurantoin or quinolones when associated with NAC in disrupting biofilm and reducing the number of vital bacterial forms, respectively, against Staphylococcus aureus, Escherichia coli and Pseudomonaceae.…”