Download PDF
Aktuelle Urol 2016; 47(03): 214-219
DOI: 10.1055/s-0042-101846
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Nicht antibiotische Strategien zur Rezidivprophylaxe von unkomplizierten Harnwegsinfektionen der Frau

Non-Antibiotic Strategies to Prevent the Recurrence of Uncomplicated Urinary Tract Infections in Women
H. W. Bauer
1   Urologische Praxis Maximilianstraße, Ludwig-Maximilians-Universität München
,
W. G. Bessler
2   Institut für Molekulare Medizin und Zellforschung der Universität Freiburg
› Author Affiliations
Further Information

Publication History

Publication Date:
03 May 2016 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Ziel ärztlichen Handelns ist das „primum nihil nocere“. Die Wiederherstellung der Integrität der intestinalen Mikrobiota und die Optimierung der Immunantwort bei rezidivierenden Infektionen, insbesondere auch im Harntrakt, stellen die Handlungsalternativen dar, die diesem Ziel eher gerecht werden als der bisher so häufig gehandhabte Focus auf die Antibiotikarezidivprophylaxe.

Auch in Zukunft wird man von Fall zu Fall Antibiotika zur Rezidivprophylaxe bei Harnwegsinfektionen empfehlen. Die Probleme des übermäßigen Gebrauchs von Antibiotika, wie Resistenzentwicklung und nachhaltige Störung der intestinalen Mikrobiota, zwingen aber nach Alternativen zu suchen. Der Einsatz von Probiotika allein oder in Kombination mit Immuntherapeutika bzw. die alleinige Gabe von Immuntherapeutika stellen wichtige Behandlungsoptionen dar, die bereits im klinischen Alltag zur Verfügung stehen. Diese Therapieansätze zielen dabei auf den Pathomechanismus einer Infektion ab und stellen eine kausale Herangehensweise an die Problematik dar. Phytotherapeutika bzw. auch kleine Moleküle wie Mannose, die die Adhärenz der Bakterien am Urothel behindern, sind ergänzende Ansätze.

Empfehlungen in der EAU-Leitlinie zur Langzeitprophylaxe von Harnwegsinfektionen sind: Orale und parenterale Immunstimulantien (StroVac®), lokale Östrogensubstitution und Gabe von Lactobacillus rhamnosus und Lactobacillus reuteri.

Abstract

The aim of all medical treatment is “primum nihil nocere” (“First, do no harm”).

Restoring the integrity of intestinal microbiota and optimising the immune response in recurrent infections, especially in the urinary tract, are treatment alternatives which are closer to this target than the usual focus on antibiotic prevention of recurrence.

In the future, antibiotics will continue to be recommended for the prevention of urinary tract infections on a case-by-case basis. However, the problems of an excessive use of antibiotics, e. g. resistance and long-term interference with intestinal microbiota, are forcing us to search for alternatives. The use of probiotics alone or in combination with immunotherapeutics, or the sole use of immunotherapeutics, are important treatment options, which are already routinely available in clinical practice. These therapies are focused on the pathomechanism of an infection and tackle the root cause of the problem. Phytotherapeutics or small molecules like mannose, which restricts the adherence of bacteria to the urothelium, are complementary approaches.

The EAU guidelines recommend the following treatments for the long-term prevention of urinary tract infections:

Oral and parenteral immunostimulants (StroVac®), local estrogen replacement and administration of Lactobacillus rhamnosus and Lactobacillus reuteri.

Schlüsselwörter

Rezidivierender Harnwegsinfekt - Probiotika - Immunstimulantien - Lokale Östrogensubstitution - Cranberry-Extrakt

Key words

recurrent urinary tract infection - probiotics - immunostimulants - local estrogen replacement - cranberry extract
 

  • Literatur

  • 1 Bauer HW. Immunologische Aspekte bei rezidivierenden Harnwegsinfektionen in bakteriellen Harnwegsinfektionen. In: Bauer HW, Hofstetter A. (Hrsg.) Klinische und experimentelle Urologie 23. München: Zuckschwerdt Verlag; 1992
    Search in Google Scholar
  • 2 Holmes AH, Moore LSP, Sundsfjord A et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet 2016; 387: 176-187
    CrossrefPubMedSearch in Google Scholar
  • 3 Relman DA. The Human Micobiome and the Future Practice of Medicine. JAMA 2015; 314: 1127-1128
    CrossrefPubMedSearch in Google Scholar
  • 4 Reid G, Bruce AW, Fraser N et al. Oral probiotics can resolve urogenital infections. FEMS Immunol Med Microbiol 2001; 30: 49-52
    CrossrefPubMedSearch in Google Scholar
  • 5 Beerepoot MAJ, ter Riet G, Nys S. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferioritay trial in prostmenopausal woman. Arch Intern Med 2012; 172: 704-712
    CrossrefPubMedSearch in Google Scholar
  • 6 Reid G, Charbonneau D, Erb J et al. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol Med Microbiol 2003; 35: 131-134
    CrossrefPubMedSearch in Google Scholar
  • 7 Petricevic L, Unger FM, Viernstein H et al. Randomized, double-blind, placebo-controlled study of oral lactobacilli to improve the vaginal flora of postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2008; 14: 54-57
    PubMedSearch in Google Scholar
  • 8 Homayouni A, Bstani P, Ziyadi S et al. Effects of probiotics on the recurrence of bacterial vaginosis: a review. J Low Genit Tract Dis 2014; 18: 79-86
    CrossrefPubMedSearch in Google Scholar
  • 9 Chisholm AH. Probiobics in Preventing Recurrent Urinary Tract Infections in Women: A Literature Review. Urol Nurs 2015; 35: 18-21
    PubMedSearch in Google Scholar
  • 10 Andrews JC, Schünemann HJ, Oxman AD et al. GRADE guidelines: 15. Going from evidence to recommendation – determinants of a recommendation´s direction and strength. J Clin Epidemiol 2013; 66: 726-735
    CrossrefPubMedSearch in Google Scholar
  • 11 Abdulwahab M, Abdulazim A, Nada MG et al. A study on the inhibitory effect of vaginal lactobacilli on uropathogenic Escherichia coli. Life Science Journal 2013; 10: 773-778
    PubMedSearch in Google Scholar
  • 12 Stapleton AE, Au-Yeung M, Hooton TM et al. Randomized, placebo-controlled phase 2 trial of a Lctobacilluas crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clin Infect Dis 2011; 52: 1212-1217
    CrossrefPubMedSearch in Google Scholar
  • 13 Lettgen B. Prevention of Recurrent Urinary Tract Infections in Female Children. Current Therapeutic Research 1996; 57: 464-475
    CrossrefPubMedSearch in Google Scholar
  • 14 Bauer HW, Bessler WG. Immunology of the Urinary Tract. CUD/EAU: International Consultation on Infection in Urology Pathogenesis: Immunology of the urinary tract 2010; 42-56
    PubMedSearch in Google Scholar
  • 15 Bauer HW, Rahlfs VW, Lauener PA et al. Prevention of recurrent urinary tract infections with immuno-active E. coli fractions: a meta-analysis of five placebo-controlled double-blind studies. Int J Antimicrob Agents 2002; 19: 451-456
    CrossrefPubMedSearch in Google Scholar
  • 16 Bauer HW, Alloussi S, Egger G et al. A Long-Term, multicenter, Double-Blind Study of an Escherichia Coli Extract (OM-89) in Female Patients with Recurrent Urinary Tract Infections. Eur Urol 2005; 47: 542-548
    CrossrefPubMedSearch in Google Scholar
  • 17 Lorenzo-Gomez MF, Padilla-Fernandez B, Garcia-Criado FJ et al. Evaluation of a therapeutic vaccine for the prevention of recurrent urinary tract infections versus prophylactic treatment with antibiotics. Int Urogynecol J 2013; 24: 127-134
    CrossrefPubMedSearch in Google Scholar
  • 18 Lorenzo-Gomez MF, Padilla-Fernandez B, Garcia-Cenador MB et al. Comparison of sublingual therapeutic vaccine with antibiotics for the prophylaxis of recurrent urinary tract infections. Front Cell Infect Microbiol 2015; 5: 50
    PubMedSearch in Google Scholar
  • 19 Fachinformation StroVac®, Dezember 2010
    PubMed
  • 20 Vahlensieck W, Bauer HW, Hoyme UB et al. Prophylaxe rezidivierender Harnwegsinfektionen (Rhwi). Nieren Hochdruckkrankheiten 2007; 36: 501-513
    PubMedSearch in Google Scholar
  • 21 Vahlensieck W. Prophylaxemaßnahmen bei rezidivierenden Harnwegsinfektionen. In: Hofstetter A. (Hrsg.) Urogenitale Infektionen. Berlin, Heidelberg, New York: Springer; 1999: 215-239
    CrossrefSearch in Google Scholar
  • 22 Uehling DT, James LJ, Hopkins WJ et al. Immunization against urinary tract infection with a multi-valent vagincal vaccine. J Urol 1991; 146: 223-225
    PubMedSearch in Google Scholar
  • 23 Ueling DT, Hopkins WJ, Elkahwaij JE et al. Phase 2 clinical trial of a vaginal mucosal vaccine for urinary tract infections. J Urol 2003; 170: 867
    CrossrefPubMedSearch in Google Scholar
  • 24 Mobley LTM, Alteri CJ. Development of a Vaccine against Escherichia coli Urinary Tract Infections. Pathogens 2015;
    PubMedSearch in Google Scholar
  • 25 Stothers L. A randomized trial to evaluate effectiveness und cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol 2002; 9: 1558-1562
    PubMedSearch in Google Scholar
  • 26 Vendrame S, Guglielmetti S, Riso P et al. Six-week consumption of a wild blueberry powder drink increases bifidobacteria in the human gut. J Agric Food Chem 2011; 59: 12815-12820
    CrossrefPubMedSearch in Google Scholar
  • 27 Schwenger EM, Tejani AM, Loewen PS. Probiotics for preventing urinary tract infections in adults and children. Chochrane Database Syst Rev 2015; 12: CD008772
    PubMedSearch in Google Scholar
  • 28 Howell AB, Botto H, Combescure C et al. Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infectious Diseases 2010; 10: 94
    CrossrefPubMedSearch in Google Scholar
  • 29 Terris MK, Issa MM, Tacker JR. Dietary supplementation with cranberry concentrate tablets may increase the risk of nephrolithiasis. Urology 2001; 57: 26-29
    PubMedSearch in Google Scholar
  • 30 Yoshimura T, Okamura H. Short term oral estriol treatment restores normal premenopausal vaginalflora to elderly women. Maturitas 2001; 39: 253-257
    CrossrefPubMedSearch in Google Scholar
  • 31 Stute P, Kiesel L. Lokale Östrogentherapie in der Postmenopause. Gynäkologische Endokrinologie. 2007 5. 150-156
    PubMedSearch in Google Scholar
  • 32 Raz R, Stamm WE. A controlled trail of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 1993; 329: 753-756
    CrossrefPubMedSearch in Google Scholar
  • 33 Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat 2007; 107: 103-111
    CrossrefPubMedSearch in Google Scholar
  • 34 AG Hormone des Berufsverbands der Frauenärzte (BVF) . Mueck AO. Anwendungsempfehlungen zur Hormonsubstitution in Klimakterium und Postmenopause. Gynäkologische Endokrinologie 2015; 13: 270-273
    CrossrefPubMedSearch in Google Scholar
  • 35 Lüthje P, Brauner H, Ramos NL et al. Estrogen supports urothelial defense mechanisms. Sci Transl med 2013; 5: 190ra80
    PubMedSearch in Google Scholar
  • 36 Moorman CN, Fowler JE. Impact of site release vaginal pH-buffer cream on introital colonization by gram-negative bacilli. J Urol 1992; 147: 1576-1578
    PubMedSearch in Google Scholar
  • 37 Kranjčec B, Papes D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol 2014; 32: 79-84
    CrossrefPubMedSearch in Google Scholar
  • 38 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 chronical recurrent lower urinary tract infections. Curr Med Res Opin 2007; 23: 2415-2422
    CrossrefPubMedSearch in Google Scholar
  • 39 Vahlensieck W, Bauer HW. Vorbeugende Therapie chronisch rezidivierender Harnwegsinfektionen (rHWI). Med Welt 2012; 63: 185-190
    PubMedSearch in Google Scholar