Phytotherapy in urinary tract

Phytotherapy is commonly defined as the study of the use of extracts of natural origin as medicines or health-promoting agents. It should be perceived as an allopathic discipline, because the effects that are expected from HMP are directed against the causes and the symptoms of a disease. – ScienceDirect

It has been revealed as a first-rate therapeutic tool to prevent and combat urinary tract infections, a pathology that ranks second in frequency among community-acquired infections, behind only respiratory conditions.

Urinary tract infections (UTIs) affect both sexes, although they are more frequent in women, mainly due to anatomical reasons (length of the urethra, absence of prostate secretions, changes in pregnancy).

37% of women have cystitis at least once in their life, and up to 20% of these infections recurs in the next two months. In fact, 12% of all women with cystitis experience recurrences, defined as three or more episodes annually, or two in the past six months.

These recurrences may be due to a relapse caused by the same bacteria, which occurs in the first two weeks after the primary infection, or they may be caused by a new infection from another microorganism outside the urinary tract, generally from the intestinal microbiota, which manifests more than two weeks instructions to pass the urine drug test by testclear powdered urine kit after the initial episode, most commonly months later.

From the etiological point of view, it is important to know the causative agent in order to establish an adequate treatment. Escherichia coli is the most frequently isolated bacterium (70-80% of cases) , both in outpatients and in hospitalized patients, although Proteus, Klebsiella or Pseudomonas are also detected with some frequency . E. coli and other bacteria have several flagella and a large number of fimbriae along their cell surface.

The fimbriae are involved in adhesion to uroepithelial cells through protein molecules called lectins. These lectins differ in the cell surface structures to which they bind; type I fimbriae of E. coli bind to mannose-containing surface glycoproteins and are readily inhibited by fructose, and P-type binds specifically to galabiose structures.

Treatment for UTI

The choice of the appropriate antibiotic treatment, in principle, is carried out empirically, choosing one of high efficacy against the germ that is suspected to have caused the infection.

Subsequently, and after the urinary culture, the drug can be modified, changing to the ideal treatment depending on the microbiological result and the sensitivity of the agent to the different antibiotics.

The appearance of adverse effects and resistance to these types of drugs makes the existence of other alternatives necessary, such as herbal medicine.

Probably the most widely used medicinal plant for the treatment and prevention of UTI is the American cranberry ( Vaccinium macrocarpon Ait.). Since due to its protoanthocyanidins type A or PAC, it has an anti-adherent activity in the uroendothelial epithelium, preventing E .coli with type P fimbriae, can monitor the progress of your infection. On the other hand, the fructose content also contributes to its non-stick role for E. coli with type I fimbriae.

Its safety of use during pregnancy, its good tolerance and the absence of significant interactions with drugs contribute to its increasingly widespread use.

There are other effective alternatives, such as heather and bearberry . In the case of heather, the action is mainly due to the stocks of PAC or condensed tannins, but it is also favored by its flavonoid content with slightly diuretic and anti-inflammatory action on the bladder walls.

Bearberry owes its properties to the content of anthraquinonic heterosides, arbutoside type, which have an antimicrobial action with tropism on the urinary tract, due to the fact that it is transformed into hydroquinone by hydrolysis carried out by the intestinal bacterial flora.

37% of women have cystitis at least once in their life, and up to 20% of these infections recurs in the next two months. It also has tannins with urinary antiseptic effect and flavonoids with a slight diuretic action.

In addition to these plants with recognized therapeutic indication in UTI, there are others that are traditionally used in this pathology. Probably the most widely used medicinal plant for the treatment and prevention of UTI is the American cranberry

Selection of phytotherapeutic treatment

The different cases that may occur in the pharmacy are analyzed below to recommend the most appropriate phytotherapeutic treatment in each one of them.

Patients without other pathology

When the person who goes to the pharmacy is an adult with an acute episode of uncomplicated cystitis, which does not present any other underlying pathology, there are several possible options:

American cranberry

Preparations that provide a daily dose equivalent to 36 mg of PAC are recommended. The part of the plant used are the fruits.

The dosage proposed by the European Scientific Cooperative on Phytotherapy (ESCOP) is 300 to 750 g / day of liquid cranberry preparations containing 25 to 100% juice or 200 to 500 mg of dry extract, twice a day or equivalent doses.

The posology proposed by the World Health Organization (WHO) differentiates whether it is prophylaxis or treatment. To prevent UTIs, he recommends 30 to 300 ml / day of preparations that contain 30% pure juice and as a treatment 360 to 960 ml of juice or 1 to 6 capsules, equivalent to 90 ml of juice per capsule, of extract concentrate per day.

When using cranberry, it is not recommended to take substances that alkalize the urine since they would decrease the effectiveness of quinic acid against Proteus mirabillis . In fact, to promote its antibacterial effect, it is advisable to take it together with 1 g of vitamin C a day.

Bearberry

It can be taken both as an infusion and as a maceration, using in both cases from 10 to 30 g of plant, finely chopped, per liter of water and it is recommended to ingest one liter a day.

The capsules or tablets must contain 270 mg of micronized leaf powder with a richness of more than 7% in arbutoside or arbutin and the recommended daily dose is 1 capsule every 6-8 hours.

Bearberry can be consumed with a content of 400 to 840 mg of arbutin per day, divided into 2 or 3 doses, for a maximum of 2 weeks and no more than five times a year.

Despite the fact that most of the active principles are found in the leaves, to prepare the preparations it is recommended to use the whole plant, because other components of the same make the urine more alkaline (a pH of approximately 8 to release hydroquinone from its conjugates).

Taking it together with substances that acidify the urine is not recommended, as they reduce the antibacterial effect of the plant. Diet also influences its effectiveness and those rich in vegetables that, in general, increase the pH, are preferable to those rich in meat and fish proteins that acidify the urine.

Patients should be warned that their urine may turn a green-brown color due to the oxidation of hydroquinone on contact with air.

Heather

It is administered in the form of an infusion made with 20 g / l and one liter is taken a day, or also in capsules containing 230 mg of micronized inflorescence powder with a content greater than 0.5% of total flavonoids and the recommended daily dose is 1 to 3 capsules every 8 hours, with a maximum of 9 capsules per day.

The use of heather is usually associated with other plants with a diuretic effect to enhance its action.

Due to the possible toxicity of hydroquinone, it is advisable to carry out discontinuous treatments, so its use for more than a week at a time or more than 5 times a year is not recommended.

Thyme

The essence of thyme exerts a urinary antiseptic effect mainly due to the action that its phenolic components: thymol and carvacrol have on the bacterial membrane.

The dosage proposed by ESCOP and Commission E is: in infusion of 1 to 2 g of dry plant in 150 ml of water, or 1 to 2 g of fluid extract, in both cases 3 to 4 times a day.

It can also be taken as a tincture (1:10) with a dosage of 40 drops up to 3 times a day or as a dry extract (from 6: 1 to 10: 1) of 75 to 200 mg, 3 times a day.

Thymol, at high doses, can cause liver toxicity, albuminuria, and haematuria, so caution is required.


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