Phytotherapie bei katheterassoziierten Harnwegsinfekten: Beobachtungsstudie zur Wirksamkeit und Sicherheit einer fixen Kombination mit Kapuzinerkressenkraut und Meerrettichwurzel

Effects of a Prophylactic Treatment with Horseradish Root and Nasturtium Herb on Urinary Tract Infections in Individuals with Chronic Neurogenic Lower Urinary Tract Dysfunction: A Retrospective Cohort Study

INTRODUCTION

Recurrent urinary tract infections (UTIs) are common in individuals with neurogenic lower urinary tract dysfunction (NLUTD) and greatly affect their quality of life. There is currently no established prophylactic measure based on evidence. We have therefore evaluated the effects of a horseradish root and nasturtium herb product on the frequency of UTIs in a retrospective cohort.

METHODS

Clinical data of patients with chronic NLUTD who were receiving the phytotherapeuticum for at least 12 months were analyzed. The number of UTIs was categorized as no UTIs, sporadic UTIs (1-2/year) and recurrent UTIs (≥3/year). The change in the annual number of patient-reported symptomatic UTIs and antibiotic prescriptions was investigated.

RESULTS

Data of 43 individuals (mean age 49 ± 13 years, median NLUTD duration 17.9 years) were analyzed. The proportion of individuals with recurrent UTIs decreased significantly (p < 0.0001) from 58.1% (42.1-73.0%) to 23.3% (11.8-38.6%) during phytotherapy, whereas the proportion of individuals without UTIs increased significantly (p = 0.001) from 14.0% (5.3-27.9%) to 39.5% (25.0-55.6%). In addition, there was a significant (p = 0.008) decrease in the number of antibiotic prescriptions.

CONCLUSION

Prophylactic treatment with horseradish root and nasturtium herb seems to be a promising option for the prevention of UTIs.

Isothiocyanates in medicine: A comprehensive review on phenylethyl-, allyl-, and benzyl-isothiocyanates

In recent years, isothiocyanates (ITCs), bioactive compounds primarily derived from Brassicaceae vegetables and herbs, have gained significant attention within the biomedical field due to their versatile biological effects. This comprehensive review provides an in-depth exploration of the therapeutic potential and individual biological mechanisms of the three specific ITCs phenylethyl isothiocyanate (PEITC), allyl isothiocyanate (AITC), and benzyl isothiocyanate (BITC), as well as their collective impact within the formulation of ANGOCIN® Anti-Infekt N (Angocin). Angocin comprises horseradish root (Armoracia rusticanae radix, 80 mg) and nasturtium (Tropaeoli majoris herba, 200 mg) and is authorized for treating inflammatory diseases affecting the respiratory and urinary tract. The antimicrobial efficacy of this substance has been confirmed both in vitro and in various clinical trials, with its primary effectiveness attributed to ITCs. PEITC, AITC, and BITC exhibit a wide array of health benefits, including potent anti-inflammatory, antioxidant, and antimicrobial properties, along with noteworthy anticancer potentials. Moreover, we highlight their ability to modulate critical biochemical pathways, such as the nuclear factor erythroid 2-related factor 2 (Nrf2)/Kelch-like ECH-associated protein 1 (Keap1), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), and signal transducer and activator of transcription (STAT) pathways, shedding light on their involvement in cellular apoptosis and their intricate role to guide immune responses.

Non-Antibiotic Prophylaxis for Recurrent UTIs in Neurogenic Lower Urinary Tract Dysfunction (NAPRUN): Study Protocol for a Prospective, Longitudinal Multi-Arm Observational Study

INTRODUCTION

Patients with neurogenic lower urinary tract dysfunction (NLUTD) reliant on intermittent self-catheterization for bladder emptying are at an increased risk of recurrent urinary tract infections (rUTI). So far, the most common practice in the prevention of rUTIs is long-term low-dose antibiotic prophylaxis, phytotherapy, and immunomodulation, whereby antibiotic prophylaxis inevitably leads to the emergence of drug-resistant pathogens and difficulty in treating infections. Therefore, non-antibiotic alternatives in the prevention of rUTIs are urgently required. We aim to identify the comparative clinical effectiveness of a non-antibiotic prophylaxis regimen in the prevention of recurrent urinary tract infections in patients with neurogenic bladder dysfunction who practice intermittent self-catheterization.

METHODS AND ANALYSIS

In this multi-centre, prospective longitudinal multi-arm observational study, a total of 785 patients practising intermittent self-catheterisation due to NLUTD will be included. After inclusion, non-antibiotic prophylaxis regimens will be instilled with either UroVaxom^® (OM-89) standard regimen, StroVac^® (bacterial lysate vaccine) standard regimen, Angocin^®, D-mannose (oral dose 2 g), bladder irrigation with saline (once per day). The management protocols will be pre-defined, but the selection of the protocol will be at the clinicians' discretion. Patients will be followed for 12 months from the onset of the prophylaxis protocol. The primary outcome is to identify the incidence of breakthrough infections. The secondary outcomes are adverse events associated with the prophylaxis regimens and the severity of breakthrough infections. Other outcomes include the exploration of change in susceptibility pattern via the optional rectal and perineal swab, as well as health-related quality of life over time (HRQoL), which will be measured in a random subgroup of 30 patients.

ETHICS AND DISSEMINATION

Ethical approval for this study has been granted by the ethical review board of the University Medical Centre Rostock (A 2021-0238 from 28 October 2021). The results will be published in a peer-reviewed journal and presented at relevant meetings.

STUDY REGISTRATION NUMBER

German Clinical Trials Register: Number DRKS00029142.

A combination of Tropaeolum majus herb and Armoracia rusticana root for the treatment of acute bronchitis

BACKGROUND

Tropaeolum majus herb (nasturtium) and Armoracia rusticana root (horseradish) produce three different isothiocyanates as secondary metabolites, which exert antibacterial, anti-inflammatory, and immune-modulatory functions in humans.

PURPOSE

Combined in the medicinal product ANGOCIN® Anti-Infekt N, the two natural components demonstrated promising effects against acute bronchitis.

STUDY DESIGN

A randomized, two-armed, placebo-controlled, double-blind, phase IV study revealed the healing fostering effect of the two herbal plant components METHODS: This study included 384 patients, with 195 in the treatment and 189 in the placebo group. The 'bronchitis severity score' (BSS) was utilized as primary endpoint. This score sums the ratings for five significant bronchitis symptoms, which are established at the patient's visits to the clinic.

RESULTS

Compared to placebo intake, the group of patients treated with the phytomedicine showed statistically significant accelerated healing of bronchitis symptoms after three days of treatment, with reductions in coughing, mucous production, and chest pain. This beneficial effect persisted for the entire duration of treatment until day ten.

CONCLUSION

In conclusion, a combination of Tropaeolum majus herb and Armoracia rusticana root promotes an elevated improvement of bronchitis symptomatology.

Phytochemical and functional analysis of horseradish (Armoracia rusticana) fermented and non-fermented root extracts

BACKGROUND

The roots of horseradish (Armoracia rusticana) are used for infections of respiratory airway and for urinary tract infections due to isothiocyanates (ITC), enzymatically formed during fermentation of glucosinolates by myrosinase.

HYPOTHESIS/PURPOSE

The present study aims to present a comprehensive overview on the phytochemical composition of A. rusticana roots, especially concerning isothiocyanates and respective glucosinolates. The complex flavonoid spectrum of the herbal material is reviewed. Published data on in vitro activity of horseradish extracts and isolated compounds are summarized. These data indicate well-established use of horseradish as an antibacterial remedy against bacterial infections of the airway and urinary tract.

STUDY DESIGN

To answer the question if other compounds from A. rusticana beside ITC contribute to the antibacterial activity, non-targeted LC-MS studies were performed with fermented and non-fermented horseradish extracts, and detailed phytochemical profiles were established.

RESULTS

Comparative investigations on the antibacterial activity indicated that only ITC-containing extracts and fractions exert antibacterial activity. The huge variety of non-ITC compounds do not significantly contribute to the antibacterial activity, but can be used for analytical characterisation and quality control of the herbal material. Detailed phytochemical analysis additionally revealed a variety of compounds, not described until now for horseradish roots: the flavonol glycosides kaempferol-3-O-β-d-xylopyranosyl-(1''' → 2'')-β-d-galactopyranoside, kaempferol-3-O-α-l-rhamnopyranosyl-(1''' → 6'')-β-d-glucopyranoside, kaempferol-3-O-β-d-glucopyranoside, Kaempferol-3-O-β-d-xylopyranosyl-7-O-β-d-glucopyranoside, Kaempferol-3-O-β-d-xylopyranosyl-(1'''' → 2''')-β-d-galactopyranoside-7-O-β-d-glucopyranoside, the oxo-indole derivative spirobrassinin, the phenylthiazole 2-methylsulfanyl-4-phenyl-4,5-dihydro-1,3-thiazole, a series of lysophophatidylethanolamine and 13 different N-phenylpropenoyl-L-amino acids.

CONCLUSION

The antibacterial effects of horseradish are only due to the presence of glucosinolates resp. the corresponding ITC, and the detailed overall composition of horseradish extracts has been reported.

How to Prevent Catheter-Associated Urinary Tract Infections: A Reappraisal of Vico's Theory-Is History Repeating Itself?

New, contextualized modern solutions must be found to solve the dilemma of catheter-associated urinary infection (CAUTI) in long-term care settings. In this paper, we describe the etiology, risk factors, and complications of CAUTI, explore different preventive strategies proposed in literature from the past to the present, and offer new insights on therapeutic opportunities. A care bundle to prevent CAUTI mainly consists of multiple interventions to improve clinical indications, identifying a timeline for catheter removal, or whether any alternatives may be offered in elderly and frail patients suffering from chronic urinary retention and/or untreatable urinary incontinence. Among the various approaches used to prevent CAUTI, specific urinary catheter coatings according to their antifouling and/or biocidal properties have been widely investigated. Nonetheless, an ideal catheter offering holistic antimicrobial effectiveness is still far from being available. After pioneering research in favor of bladder irrigations or endovesical instillations was initially published more than 50 years ago, only recently has it been made clear that evidence supporting their use to treat symptomatic CAUTI and prevent complications is needed.

Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects

Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection and cause of secondary bloodstream infections. Despite many advances in diagnosis, prevention and treatment, CAUTI remains a severe healthcare burden, and antibiotic resistance rates are alarmingly high. In this review, current CAUTI management paradigms and challenges are discussed, followed by future prospects as they relate to the diagnosis, prevention, and treatment. Clinical and translational evidence will be evaluated, as will key basic science studies that underlie preventive and therapeutic approaches. Novel diagnostic strategies and treatment decision aids under development will decrease the time to diagnosis and improve antibiotic accuracy and stewardship. These include several classes of biomarkers often coupled with artificial intelligence algorithms, cell-free DNA, and others. New preventive strategies including catheter coatings and materials, vaccination, and bacterial interference are being developed and investigated. The antibiotic pipeline remains insufficient, and new strategies for the identification of new classes of antibiotics, and rational design of small molecule inhibitor alternatives, are under development for CAUTI treatment.

[Uncomplicated urinary tract infections : Use of mustard oils]

BACKGROUND

Increasing rates of multidrug resistant bacteria demand a change in managing infectious diseases. New ways of antibiotic-free treatment in uncomplicated urinary tract infections (UTI) saving antibiotics for severe infections should be chosen.

OBJECTIVES

Beside analgesics for purely symptomatic treatment, herbal medicine can be used for uncomplicated UTI instead of antibiotics.

MATERIALS AND METHODS

Anti-infectious phytodrugs like isothiocyanates (ITC) from horseradish and cress (nasturtium) have been thoroughly examined scientifically.

RESULTS

ITC showed multitarget effects in many pharmacological studies. Beside anti-inflammatory effects, a broad spectrum of species, including multiresistant bacteria were covered. Positive results and good compatibility are documented in several studies for therapy of uncomplicated UTI and respiratory infections with horseradish and cress as well as for prophylaxis in recurrent UTI (recommendation in the German S3 guideline for uncomplicated urinary tract infections, AWMF registry 043/044, statement 8.1.d.4 on prophylaxis).

CONCLUSION

Using isothiocyanates (ITC) for therapy and prophylaxis in uncomplicated urinary tract infections is a rational approach and helps to save antibiotics. Even after long-term use, development of resistance has not yet been observed and is not probable due to the multimodal mechanism of action of ITC.

Medicinal plants consumption against urinary tract infections: a narrative review of the current evidence

INTRODUCTION

Urinary tract infections (UTIs) are usual diseases caused by different strains of microorganisms. Many antibiotics have been applied for the treatment of these infections. However, the development of multidrug-resistant strains is a major problem in these treatments. As alternative complementary agents, several medicinal plants are often used to prevent and/or treat these diseases.

AREAS COVERED

This review summarized the current evidence about the efficacy of medicinal plants' consumption to prevent and/or co-treat UTIs. The most precise scientific databases, e.g. Medline, Scopus, and Web of Science were comprehensively searched, using relative keywords to identify the relative in vivo and ex vivo animal and human studies.

EXPERT OPINION

Current studies supported evidence for potential benefit overall concerning medicinal plants' consumption against UTIs by preventing bacterial adherence and inhibiting inflammation cascades through responding immunologically to bacteria invasion. However, most of the current evidence have been focused on in vivo and ex vivo animal studies, while human studies are currently limited and did not focus on a specific medicinal plant. Thus, well-designed clinical trials for long study periods focused on individual medicinal plants are intensely recommended to delineate their effectiveness on the prevention and/or co-treatment of UTIs.