Herbal components in the complex therapy of acute cystitis in women: optimization of efficacy, prevention and safety

Authors

DOI:

https://doi.org/10.15574/PP.2024.3(99).712

Keywords:

herbal medicine, immunity, oxidative stress, acute cystitis, relapse

Abstract

Aim - to study anti-inflammatory and antioxidant effects of phytochemicals in young women with acute cystitis.

Materials and methods. The study included 50 women with acute cystitis aged between 18 and 35 years. The patients were divided into two groups. The control group (n=25) received standard antibacterial therapy for 7 days, and patients in the intervention group (n=25) additionally took a combined herbal preparation at a dosage of 1 capsule twice a day for 30 days and then a further 60 days at a dosage of 1 capsule once a day. Follow-up visits were made 7 days, 1 month and 3 months after the start of treatment. During the study, the dynamics of the complaints, the results of the ACSS questionnaire, laboratory tests of urine and blood were evaluated, and the parameters of the oxidative stress-antioxidant status system were determined.

Results. After the course of etiotropic treatment, it was found that the average duration of acute cystitis` symptoms in the control group was 1.67 times longer than in the intervention group. After one month of taking the herbal combination drug, the antioxidant defence system was stabilized: the indicators of oxidative stress in the intervention group had a significantly greater positive dynamic than in the control group; the indicators of the antioxidant system reached normal levels and had significant differences compared to the control group. In the intervention group, there was a restoration of neutrophil membrane-associated pyridine nucleotide oxidase activity and an increase in the functional reserve of phagocytic cells, a significant increase in the number of cells capable of phagocytosis was noted, and the absorptive activity of neutrophils was also significantly higher than in the control group. During the 3-month prophylactic course of treatment with the herbal remedy, the absence of recurrent disease was observed in 96% of patients in the intervention group, in contrast to the control group, where the absence of reinfection was observed in only 72% of patients.

Conclusions. The use of a combined herbal preparation at a dosage of 1 capsule twice a day in addition to standard therapy for acute cystitis in women significantly reduces the duration of clinical symptoms and promotes faster clinical and laboratory recovery. After 30 days of use, oxidative stress, antioxidant protection and phagocytic activity of neutrophils are normalized. Complex therapy of acute cystitis with the inclusion of herbal medicine for 3 months is associated with a significantly lower number of cases of urinary tract reinfection compared with treatment without herbal medicine.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

References

Allameh Z, Salamzadeh J. (2016). Use of antioxidants in urinary tract infection. Journal of research in pharmacy practice. 5(2): 79-85. https://doi.org/10.4103/2279-042X.179567; PMid:27162800 PMCid:PMC4843588

Al-Mamun MA, Husna J, Khatun M, Hasan R, Kamruzzaman M, Hoque KM et al. (2016, May 31). Assessment of antioxidant, anticancer and antimicrobial activity of two vegetable species of Amaranthus in Bangladesh. BMC Complement Altern Med. 16: 157. https://doi.org/10.1186/s12906-016-1130-0; PMid:27246877 PMCid:PMC4888664

Amayun I. (2021). Adherence to recent antibiotic guidelines for acute uncomplicated cystitis. Journal of the American Association of Nurse Practitioners. 33(11): 879-885. https://doi.org/10.1097/JXX.0000000000000526; PMid:33731550

Anokhina H.A. Rol diietychnoho kharchuvannia ta fitoterapii v profilaktytsi ta likuvanni SKKh. Nyrky. Fitoterapiia v urolohii i nefrolohii. 2: 2013.

Aragona SE, Ciprandi G, Study Group on Urinary Infections: Vasciaveo L, Cantelmi M, Ciavolino G et al. (2021). Acute uncomplicated cystitis management in clinical practice: a nationwide survey. Journal of biological regulators and homeostatic agents. 35(3): 1097-1101. https://doi.org/10.23812/21-159-L.

Borges MFdA, Lacerda RdS, Correia JPdA, de Melo TR, Ferreira SB. (2022). Potential Antibacterial Action of -Pinene. Med. Sci. Forum. 12: 11. https://doi.org/10.3390/eca2022-12709; PMid:36459239

Bouyahyaoui A, Bahri F, Romane A, Höferl M, Wanner J et al. (2016, Apr). Antimicrobial Activity and Chemical Analysis of the Essential Oil of Algerian Juniperus phoenicea. Nat Prod Commun. 11(4): 519-522. PMID: 27396209. https://doi.org/10.1177/1934578X1601100426

Chenoweth CE. (2021). Urinary Tract Infections: 2021 Update. Infectious disease clinics of North America. 35(4): 857-870. https://doi.org/10.1016/j.idc.2021.08.003; PMid:34752223

Dalghi MG, Montalbetti N, Carattino MD, Apodaca G. (2020). The Urothelium: Life in a Liquid Environment. Physiological reviews. 100(4): 1621-1705. https://doi.org/10.1152/physrev.00041.2019; PMid:32191559 PMCid:PMC7717127

Daoudi A, Aarab L, Abdel-Sattar E. (2013, Apr). Screening of immunomodulatory activity of total and protein extracts of some Moroccan medicinal plants. Toxicology and Industrial Health. 29(3): 245-253. Epub 2012 Feb 2. https://doi.org/10.1177/0748233711430972; PMid:22301818

Dwyer DJ, Belenky PA, Yang JH, MacDonald IC, Martell JD, Takahashi N et al. (2014). Antibiotics induce redox-related physiological alterations as part of their lethality. Proceedings of the National Academy of Sciences of the United States of America. 111(20): E2100-E2109. https://doi.org/10.1073/pnas.1401876111; PMid:24803433 PMCid:PMC4034191

El Mihyaoui A, Esteves da Silva JCG, Charfi S, Candela Castillo ME, Lamarti A, Arnao MB. (2022). Chamomile (Matricaria chamomilla L.): A Review of Ethnomedicinal Use, Phytochemistry and Pharmacological Uses. Life (Basel, Switzerland). 12(4): 479. https://doi.org/10.3390/life12040479; PMid:35454969 PMCid:PMC9032859

Ener K, Keske M, Aldemir M, Özcan MF, Okulu E, Özayar A et al. (2015). Evaluation of oxidative stress status and antioxidant capacity in patients with painful bladder syndrome/interstitial cystitis: preliminary results of a randomised study. International urology and nephrology. 47(8): 1297-1302. https://doi.org/10.1007/s11255-015-1021-1; PMid:26049975

Ez-zahir A, Lahna A, Marnissi F, Oudghiri M, Naya A. (2022, Sep). Immuno-Modulatory, Anti-Psoriatic Effects and Furanochromone (Khellin and Visnagin) Contents of Ammi Visnaga (L.) Hydroethanolic Extract. Biomedical & Pharmacology Journal. 15(3): 1623-1635. https://doi.org/10.13005/bpj/2500

Feirouz B, Salima KG. (2014). Antibacterial Activity and Chemical Composition of Ammi visnaga L. Essential Oil Collected from Boumerdes (Algeria) During Three Periods of the Plant Growth. Journal of Essential Oil Bearing Plants. 17(6): 1317-1328. https://doi.org/10.1080/0972060X.2014.912164

Frazier RL, Huppmann AR. (2020). Educational Case: Acute Cystitis. Academic pathology. 7: 2374289520951923. https://doi.org/10.1177/2374289520951923; PMid:32974422 PMCid:PMC7495512

Göger G, Demirci B, Ilgın S, Demirci F. (2018). Antimicrobial and toxicity profiles evaluation of the Chamomile (Matricaria recutita L.) essential oil combination with standard antimicrobial agents. Industrial Crops & Products. 120: 279-285, 280. https://doi.org/10.1016/j.indcrop.2018.04.024

Gonçalves AC, Flores-Félix JD, Coutinho P, Alves G, Silva LR. (2022). Zimbro (Juniperus communis L.) as a Promising Source of Bioactive Compounds and Biomedical Activities: A Review on Recent Trends. International journal of molecular sciences. 23(6): 3197. https://doi.org/10.3390/ijms23063197; PMid:35328621 PMCid:PMC8952110

Gupta K, Grigoryan L, Trautner B. (2017). Urinary Tract Infection. Annals of internal medicine. 167(7): ITC49-ITC64. https://doi.org/10.7326/AITC201710030; PMid:28973215

Haindongo N et al. (2021). Antibacterial and antibiofilm effects of garlic (Allium sativum), ginger (Zingiber officinale) and mint (Mentha piperta) on Escherichia coli biofilms. Food Science and Applied Biotechnology. 4(2): 166-176. https://doi.org/10.30721/fsab2021.v4.i2.146

Hajrah N, Abdul WM, Sabir J, Al-Garni SMS, Sabir M, El-hamidy SMA et al. (2018). Anti-bacterial activity of Ricinus communis L. against bacterial pathogens Escherichia coli and Klebsiella oxytoca as evaluated by Transmission electron microscopy. Biotechnology & Biotechnological Equipment. 32(3): 686-691. https://doi.org/10.1080/13102818.2018.1451778

Hernández-Hernández D, Ortega-González Y, Padilla-Fernández B, Gutiérrez-Hernández PR, Castro-Díaz DM. (2023). Management of Acute Cystitis in the Era of COVID-19. Current bladder dysfunction reports. 18(1): 10-15. https://doi.org/10.1007/s11884-022-00677-0; PMid:36466948 PMCid:PMC9684745

Jackson AR, Ching CB, McHugh KM, Becknell B. (2020). Roles for urothelium in normal and aberrant urinary tract development. Nature reviews. Urology. 17(8): 459-468. https://doi.org/10.1038/s41585-020-0348-2; PMid:32647226 PMCid:PMC8966489

Jeyaseelan EC, Jashothan PT. (2012, Sep). In vitro control of Staphylococcus aureus (NCTC 6571) and Escherichia coli (ATCC 25922) by Ricinus communis L. Asian Pac J Trop Biomed. 2(9): 717-721. PMCID: PMC3609375. https://doi.org/10.1016/S2221-1691(12)60216-0; PMid:23570001

Khalil N, Bishr M, Desouky S, Salama O. (2020). Ammi Visnaga L., a Potential Medicinal Plant: A Review. Molecules (Basel, Switzerland). 25(2): 301. https://doi.org/10.3390/molecules25020301; PMid:31940874 PMCid:PMC7024292

Kulchavenya E. (2018). Acute uncomplicated cystitis: is antibiotic unavoidable? Therapeutic advances in urology. 10(9): 257-262. https://doi.org/10.1177/1756287218783644; PMid:30116301 PMCid:PMC6088498

Kurutas EB, Ciragil P, Gul M, Kilinc M. (2005). The effects of oxidative stress in urinary tract infection. Mediators of inflammation. 2005(4): 242-244. https://doi.org/10.1155/MI.2005.242; PMid:16192676 PMCid:PMC1526480

Lala V, Leslie SW, Minter DA. (2023). Acute Cystitis. In StatPearls. StatPearls Publishing.

Leite-Sampaio NF, Gondim CNFL, Martins RAA, Siyadatpanah A, Norouzi R, Kim B et al. (2022, May 25). Potentiation of the Activity of Antibiotics against ATCC and MDR Bacterial Strains with (+)-α-Pinene and (-)-Borneol. Biomed Res Int. 2022: 8217380. https://doi.org/10.1155/2022/8217380; PMid:35663042 PMCid:PMC9159878

Marwa C, Fikri-Benbrahim K, Ou-Yahia D, Farah A. (2017, Jul-Sep). African peppermint (Mentha piperita) from Morocco: Chemical composition and antimicrobial properties of essential oil. J Adv Pharm Technol Res. 8(3): 86-90. https://doi.org/10.4103/japtr.JAPTR_11_17; PMid:28795021 PMCid:PMC5527698

Mourenza Á, Gil JA, Mateos LM, Letek M. (2020). Oxidative Stress-Generating Antimicrobials, a Novel Strategy to Overcome Antibacterial Resistance. Antioxidants (Basel, Switzerland). 9(5): 361. https://doi.org/10.3390/antiox9050361; PMid:32357394 PMCid:PMC7278815

Mourenza Á, Gil JA, Mateos LM, Letek M. (2021). Novel Methods to Identify Oxidative Stress-Producing Antibiotics. Methods in molecular biology (Clifton, N.J.). 2296: 249-261. https://doi.org/10.1007/978-1-0716-1358-0_15; PMid:33977453

Muntean D, Licker M, Alexa E, Popescu I, Jianu C, Buda V et al. (2019, Sep 13). Evaluation of essential oil obtained from Mentha×piperita L. against multidrug-resistant strains. Infect Drug Resist. 12: 2905-2914. https://doi.org/10.2147/IDR.S218141; PMid:31686869 PMCid:PMC6751511

Neugent ML, Hulyalkar NV, Nguyen VH, Zimmern PE, De Nisco NJ. (2020). Advances in Understanding the Human Urinary Microbiome and Its Potential Role in Urinary Tract Infection. mBio. 11(2): e00218-20. https://doi.org/10.1128/mBio.00218-20; PMid:32345639 PMCid:PMC7188990

Sah A, Naseef PP, Kuruniyan MS, Jain GK, Zakir F, Aggarwal G. (2022). A Comprehensive Study of Therapeutic Applications of Chamomile. Pharmaceuticals (Basel, Switzerland). 15(10): 1284. https://doi.org/10.3390/ph15101284; PMid:36297396 PMCid:PMC9611340

Salehi B, Upadhyay S, Erdogan Orhan I, Kumar Jugran A, L D Jayaweera S, A Dias D et al. (2019, Nov 14). Therapeutic Potential of α- and β-Pinene: A Miracle Gift of Nature. Biomolecules. 9(11): 738. https://doi.org/10.3390/biom9110738; PMid:31739596 PMCid:PMC6920849

Sandasi M, Leonard CM, Van Vuuren SF, Viljoen AM. (2011). Peppermint (Mentha piperita) inhibits microbial biofilms in vitro. South African Journal of Botany. 77; 1: 80-85. https://doi.org/10.1016/j.sajb.2010.05.011

Tahmouzi S, Ghodsi M. (2014, Nov 4). Optimum extraction of polysaccharides from motherwort leaf and its antioxidant and antimicrobial activities. Carbohydr Polym. 112: 396-403. Epub 2014 Jun 19. https://doi.org/10.1016/j.carbpol.2014.06.024; PMid:25129759

Williams NA, Barnard L, Allender CJ, Bowen JL, Gumbleton M, Harrah T et al. (2016). Evidence of Nonuniformity in Urothelium Barrier Function between the Upper Urinary Tract and Bladder. The Journal of urology. 195(3): 763-770. https://doi.org/10.1016/j.juro.2015.10.066; PMid:26478446

Xu Z, Elrashidy RA, Li B, Liu G. (2022). Oxidative Stress: A Putative Link Between Lower Urinary Tract Symptoms and Aging and Major Chronic Diseases. Frontiers in medicine. 9: 812967. https://doi.org/10.3389/fmed.2022.812967; PMid:35360727 PMCid:PMC8960172

Published

2024-09-28