L-Methionine associated with Hibiscus sabdariffa and Boswellia serrata extracts are not inferior to antibiotic treatment for symptoms relief in patients affected by recurrent uncomplicated urinary tract infections: Focus on antibiotic-sparing approach


Submitted: March 19, 2018
Accepted: March 25, 2018
Published: June 30, 2018
Abstract Views: 3618
PDF: 1273
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Authors

  • Tommaso Cai Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
  • Andrea Cocci Department of Urology, University of Florence, Florence, Italy.
  • Daniele Tiscione Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
  • Marco Puglisi Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
  • Fabrizio Di Maida Department of Urology, University of Florence, Florence, Italy.
  • Gianni Malossini Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
  • Paolo Verze Department of Urology, University of Naples, Federico II, Naples, Italy.
  • Alessandro Palmieri Department of Urology, University of Naples, Federico II, Naples, Italy.
  • Vincenzo Mirone Department of Urology, University of Naples, Federico II, Naples, Italy.
  • Truls E. Bjerklund Johansen Department of Urology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Objective: To evaluate the efficacy of a phytotherapic combination of L-Methionine associated with Hibiscus sabdariffa and Boswellia serrata for treatment of acute episodes of uncomplicated urinary tract infections (UTI) in women affected by recurrent UTIs.
Materials and methods: In this randomized phase III clinical trial, adult females with uncomplicated UTI were enrolled into one of the following treatment groups: Group A: phytotherapic combination 1 tablet in the morning and 1 tablet in the evening for 7 days; Group B: Short term antibiotic treatment according to international guidelines recommendations. At baseline, all patients were evaluated by a urologist and quality of life (QoL) questionnaires and mid-stream urine culture. Same clinical and laboratory investigations were repeated at each follow-up visit.
Results: Forty-six patients were enrolled in Group A and 47 in Group B. At the first follow-up (30 days), both groups showed a statistically significant improvement in quality of life scores as compared with baseline assessment [Group A: (QoL 94.3 VS 98.5 p < 0.001); Group B: (QoL 94.5 VS 98.7 p < 0.001)]. An improvement from baseline was also seen at the second followup evaluation after 3 months [Group A: (QoL 94.3 VS 99.1 p < 0.001); Group B: (QoL 94.5 VS 98.1 p < 0.001)]. At the second follow-up visit, a statistically significant difference in QoL was reported between the two groups (99.1 VS 98.1; p < 0.003) and a transition from UTI to asymptomatic bacteriuria (ABU) was observed 12 of 46 (26%) patients in Group A, while no patients in Group B demonstrated ABU (p = 0.007).
Conclusions: Here, we demonstrated that this phytotherapic combination is able, in comparison to antibiotic treatment, to improve patients quality of life, reducing symptoms in acute setting and preventing the recurrences. Interestingly, a significantly higher proportion of patients in the phytotherapy group had ABU after three months. Our findings are of great interest in an antibiotic stewardship perspective.

Cai, T., Cocci, A., Tiscione, D., Puglisi, M., Di Maida, F., Malossini, G., Verze, P., Palmieri, A., Mirone, V., & Bjerklund Johansen, T. E. (2018). L-Methionine associated with Hibiscus sabdariffa and Boswellia serrata extracts are not inferior to antibiotic treatment for symptoms relief in patients affected by recurrent uncomplicated urinary tract infections: Focus on antibiotic-sparing approach. Archivio Italiano Di Urologia E Andrologia, 90(2), 97–100. https://doi.org/10.4081/aiua.2018.2.97

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