Alternative treatments for female urinary tract infections: microbiological analysis of herbal medicinal product, and qualitative study into patients' perspectives

Abstract

Urinary tract infections (UTI) are one of the most common female conditions treated by general practitioners, and most patients are prescribed antibiotics. As bacterial resistance to antibiotics is on the increase there is a need to find alternative treatments to alleviate the uncomfortable symptoms of this condition. The herbal medicinal product (HMP) Arctostaphylos uva-ursi (uva-ursi) has traditionally been used to treat UTI and was, for the first time, being tested in a major clinical trial. This study aimed to support the trial by examining the quality of HMPs, assessing dosing and safety issues, and analysing the possible antibacterial effect and mechanism of action of uva-ursi. In addition, a qualitative study was conducted which explored patients’ views on using an HMP for symptom relief of a UTI.

This study found that both uva-ursi and its metabolite hydroquinone (Hq), regarded as the main active constituent, demonstrated antibacterial activity against several named bacteria (including E. coli) in concentrations ranging from 32–512 µg/mL. The literature reported that urine required alkalisation for the release of Hq from uva-ursi metabolites, but that activity of Hq itself was unaffected by pH. However, this study determined that Hq increased activity at alkaline pH in vitro against E. coli. Moreover, the successful inhibition of growth of E. coli in the urine of healthy volunteers (at 50 colony forming units/mL) after taking uva-ursi was unaffected by an alkaline pH. In 2 out of the 4 volunteers antimicrobial activity increased the longer uva-ursi was taken.

Aggregation of E. coli was observed in the presence of the HMP compared to control samples in vitro, which may cause the bacteria to be flushed out of the urinary tract, suggesting there may be more than one mode of antimicrobial action.

The qualitative study identified that the participants were aware of antibiotic resistance, but that this knowledge did not deter them from seeking and expecting antibiotics if they wanted symptom relief from a UTI. Were an HMP shown to alleviate symptoms of UTI, based on this sample there would be few barriers to adopting it as an alternative treatment.

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ORCID for Michael Moore: orcid.org/0000-0002-5127-4509

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