In vitro efficacy of phytotherapeutics suggested for prevention and therapy of urinary tract infections
To analyse the therapeutic efficacy of various phytotherapeutics and their antimicrobial compounds with regard to strain specificity and dose dependence.
A representative strain collection of 40 uropathogenic bacteria isolated from complicated and uncomplicated urinary tract infection was subjected to various virulence assays (bacterial growth, mannose-sensitive agglutination, and motility) to determine the therapeutic impact of various compounds with antimicrobial activity. We tested proanthocyanidins (PAC), d-mannose, rosemary extract (Canephron®), and isothiocyanates (Angocin®).
d-mannose efficiently blocked the adhesive properties of all type 1 fimbriae-positive isolates in low concentration (0.2%), but showed no bacteriostatic effect. PAC also actively blocked agglutination, but the concentration varied considerably among isolates. Escherichia coli required the highest concentration (10%), while Enterobacter cloacae responded to low concentrations (0.1%). Allyl isothiocyanates not only impaired agglutination in all tested isolates, but also had a dramatic impact on flagella-mediated motility in Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis (p < 0.001). The administration of rosemary extracts revealed a strong bacteriostatic effect in growth assays. All tested strains were strongly inhibited by the addition of 10 μg/ml or 1 μg/ml of purified rosemary extractions with the exception of Serratia marcescens. Morganella morganii responded only to 10 μg/ml.
Phytotherapeutics and small-molecular compounds like mannosides have the potential to become an integral part in a multi-modal treatment concept for the treatment and prevention of urinary tract infections. Their efficiency can be optimised when strain specificities and therapeutic concentrations are taken into account.
KeywordsUrinary tract infections Phytotherapeutics Prevention Therapy Uropathogenic Escherichia coli (UPEC)
JM: project development, data collection and analysis, and manuscript writing. SS: supervision. CGS: project development and supervision. GM: project development, data collection and analysis, and manuscript writing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
- 1.O’Neill J. Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Rev Antimicrob Resist. 2014;1:1–16.Google Scholar
- 12.Bonkat G, Bartoletti R, Cai T, Bruyere F, et al. EAU guidelines on urological infections. Edn. presented at the EAU Annual Congress Copenhagen 2018. ISBN 978-94-92671-01-1.Google Scholar
- 15.Jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008;10:CD001321.Google Scholar
- 16.Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:001321.Google Scholar
- 26.Huttner A, Hatz C, van den Dobbelsteen G, Abbanat D, Hornacek A, Frolich R, et al. Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial. Lancet Infect Dis. 2017;17:528–37.CrossRefGoogle Scholar
- 30.Wagenlehner FM, Abramov-Sommariva D, Holler M, Steindl H, Naber KG. Non-antibiotic herbal therapy (BNO 1045) versus antibiotic therapy (fosfomycin trometamol) for the treatment of acute lower uncomplicated urinary tract infections in women: a double-blind, parallel-group, randomized, multicentre, non-inferiority phase III trial. Urol Int. 2018;101:327–36.CrossRefGoogle Scholar
- 32.Albrecht U, Goos KH, Schneider B. A randomised, double-blind, placebo-controlled trial of a herbal medicinal product containing Tropaeoli majoris herba (Nasturtium) and Armoraciae rusticanae radix (Horseradish) for the prophylactic treatment of patients with chronically recurrent lower urinary tract infections. Curr Med Res Opin. 2007;23:2415–22.CrossRefGoogle Scholar
- 33.Lau I, Albrecht U, Kirschner-Hermanns R. Phytotherapy in catheter-associated urinary tract infection: observational study recording the efficacy and safety of a fixed herbal combination containing Tropaeoli majoris herba and Armoraciae rusticanae radix. Urologe A. 2018;57:1472–80.CrossRefGoogle Scholar