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Der Urologe

, 48:1203 | Cite as

Mythos oder Wahrheit

„Cranberry-Saft“ in der Prophylaxe und Behandlung von rezidivierenden Harnweginfektionen
  • M.J. MathersEmail author
  • F. von Rundstedt
  • A.S. Brandt
  • M. König
  • D.A. Lazica
  • S. Roth
Übersichten

Zusammenfassung

Rezidivierende Harnweginfektionen (HWI) sind ein häufiges Problem in der urologischen Praxis. Bei einer antibiotischen Langzeitprophylaxe (LP) muss mit einer Selektion resistenter Darmbakterien gerechnet werden und nach Abschluss der LP treten die häufigen HWI-Frequenzen wieder auf. Durch allgemeine Empfehlungen konnte in kontrollierten Studien eine Rezidivfreiheit nachgewiesen werden. Eine dieser Empfehlungen ist die Einnahme von Cranberry (Moosbeere). Sowohl die Literaturrecherche in Pubmed als auch das kürzlich erschienene „Cochrane Database Systematic Review“ bestätigen Hinweise, dass der tägliche Konsum von Cranberry-Extrakten HWI verhindern soll. In-vitro-Studien zeigen, dass die Bindungsfähigkeit insbesondere der p-Fimbrien der Escherichia coli mit den Uroepithelzellen durch die Anwesenheit von Proanthocyaniden, den wirksamen Inhaltsstoffen der Cranberry, verhindert werden kann. In klinischen Studien ist die Evidenz nicht so ausgeprägt. Viele Bakterien besitzen zwar Fimbrien, aber nur wenige Subpopulationen besitzen p-Fimbrien, P-Fimbrien sind bei Escherichia coli hingegen wesentlich häufiger, wodurch die Adhäsion verhindert werden kann. Allerdings konnten randomisierte und kontrollierte Studien zeigen, dass in der Subanalyse Frauen mit rezidivierenden HWI dennoch profitierten.

Schlüsselwörter

Cranberry Harnweginfekt Prophylaxe Wirkungsmechanismus 

Myth or truth

Cranberry juice for prophylaxis and treatment of recurrent urinary tract infection

Abstract

Recurrent urinary tract infections are a frequent problem in urological practice. Long-term antibiotic prophylaxis can cause resistance of some intestinal bacteria, and after therapy is stopped, infections often resume. In controlled studies, general recommendations for prophylaxis were shown to inhibit reinfection. One of these recommendations is the consumption of cranberries. A review of the literature in PubMed as well as the recently published Cochrane database systematic review confirmed that daily consumption of cranberries prevents recurrent urinary tract infections. In vitro studies have shown that binding of the P fimbriae of Escherichia coli to the uroepithelial tissue can be inhibited in the presence of proanthocyanidins, the active ingredient of cranberries. In clinical studies, the evidence is not so pronounced. Many other bacteria have fimbriae, but only a few subpopulations have P fimbriae. P fimbriae are frequent in E. coli, so this adhesion can be prevented. However, in a subanalysis of randomized and controlled studies, it was shown that women with recurrent urinary tract infections might profit from consuming cranberries.

Keywords

Cranberry Urinary tract infection Prophylaxis Mechanism of action 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Jepson RG, Craig JC (2008) Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev CD001321Google Scholar
  2. 2.
    Foo LY, Lu Y, Howell AB, Vorsa N (2000) The structure of cranberry proanthocyanidins which inhibit adherence of uropathogen P-fimbriated Escherichia coli in vitro. Phytochemistry 54:173–181PubMedCrossRefGoogle Scholar
  3. 3.
    Ferreira D, Slade D (2002) Oligomeric proanthocyanidins: naturally occurring O-heterocycles. Nat Prod Rep 19:517–541PubMedCrossRefGoogle Scholar
  4. 4.
    Di Martino P, Agniel R, David K et al (2006) Reduction of escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a dobble-blind randomized placebo-controlled cross-over trail. World J Urol 24(1):21–27CrossRefGoogle Scholar
  5. 5.
    Blatherwick NR (1914) The specific role of foods in relation to the composition to urine. Arch Intern Med 14:409–450Google Scholar
  6. 6.
    Fellers CR, Redmon BC, Parrott EM (1933) Effect of cranberries on urinary acidity and blood alkali reserve. J Nutr 6:455–463Google Scholar
  7. 7.
    Bredel PT, Cotran R, Kass EH (1959) Cranberry juice and the antibacterial action of hippuric acid. J Lab Clin Med 54:881–888Google Scholar
  8. 8.
    Parsons CL (1986) Pathogenesis of urinary tract infections: bacterial adherence, bladder defense mechanisms. Urol Clin North Am 13:563–568PubMedGoogle Scholar
  9. 9.
    Arthur M, Johnson CE, Rubin RJ et al (1989) Molecular epidemiology of adhesion and hemolysin virulence factors among uropathogenic escherichia coli. Infect Immun 57:303–313PubMedGoogle Scholar
  10. 10.
    Rice CL (1986) Pathogenesis of urinary infections: bacterial adherence, bladder defence mechanisms. Urol Clin North Am 13:563–568Google Scholar
  11. 11.
    Sabota AE (1984) Inhibition of bacterial adherence by cranberry juice: potential use for the treatment of urinary tract infections. J Urol 131:1013–1016Google Scholar
  12. 12.
    Schmidt DR, Sabota AE (1988) An examination of the anti-adherence activity of cranberry juice on urinary and non-urinary bacterial isolates. Microbis 55:173–181Google Scholar
  13. 13.
    Zafriri D, Ofeck I, Pocino M et al (1989) Inhibitory activity of cranberry juice on the adherence of Type 1 and P Fimbriated Escherichia coli to eukaryotic cells. Antimicrob Agents Chemother 33:92–98PubMedGoogle Scholar
  14. 14.
    Ofek I, Goldhar J, Zafriri D et al (1991) Anti-escharichia coli adhesion activity of cranberry and blueberry juices. N Engl J Med 324:1599PubMedGoogle Scholar
  15. 15.
    Howell Amy B et al (1998) Inhibition of the adherence of p-fimbriated Escherichia coli to uroepithelial cell surfaces by proanthocyanidin extracts from cranberries. N Engl J Med 339:1085PubMedCrossRefGoogle Scholar
  16. 16.
    Ahuja S, Kaack B, Roberts J (1998) Loss of fimbrial adhesion with the addition of vaccinium macrocarpon to the growth medium of p-fimbriated E. coli. J Urol 159:559–562PubMedCrossRefGoogle Scholar
  17. 17.
    Liu Y, Black MA, Caron L, Camesano TA (2006) Role of cranberry juice on molecular-scale surface characteristics and adhesion behavior of Escherichia coli. Biotechnol Bioeng 93(2):297–305PubMedCrossRefGoogle Scholar
  18. 18.
    Avorn J, Monane M, Gurwitz JH et al (1994) Reduction of bacteria and pyuria after ingestion of cranberry and blueberry juices. J Am Med Assoc 271(10):751CrossRefGoogle Scholar
  19. 19.
    Schlager TA, Anderson S, Trudell J et al (1999) Effect of cranberry juice on bacteria in children with neurogenic bladder receiving intermittent catheterization. J Pediatr 135:698–702PubMedCrossRefGoogle Scholar
  20. 20.
    Kontiokari T, Sundquist K, Nuutinen M et al (2001) Randomized trail of cranberry-lingonberry juice and lactobacillus GG drink for the prevention of urinary tract infections in women. Br Med J 322:1571CrossRefGoogle Scholar
  21. 21.
    Haverkorn MJ, Mandigers J (1994) Reduction of bacteriuria and pyuria using cranberry juice. JAMA 272:590PubMedCrossRefGoogle Scholar
  22. 22.
    Foxman B, Geiger AM, Palin K et al (1995) First-time urinary tract infection and sexual behavior. Epidemiology 6:163–168CrossRefGoogle Scholar
  23. 23.
    Stothers L (2002) A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol 9(3):1558–1562PubMedGoogle Scholar
  24. 24.
    Foda MM, Middlebrook PF, Gatfield CT et al (1995) Efficacy of cranberry in prevention of urinary tract infection in a susceptible pediatric population. Can J Urol 2(1):98–102PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  • M.J. Mathers
    • 1
    Email author
  • F. von Rundstedt
    • 2
  • A.S. Brandt
    • 2
  • M. König
    • 1
  • D.A. Lazica
    • 2
  • S. Roth
    • 2
  1. 1.Urologische Gemeinschaftspraxis Remscheid, Kooperationspraxis der Klinik für Urologie und KinderurologieKlinikum Wuppertal, Universität Witten/HerdeckeRemscheidDeutschland
  2. 2.Klinik für Urologie und KinderurologieKlinikum Wuppertal, Universität Witten/HerdeckeWuppertalDeutschland

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