Bacterial Urinary Tract Infection

The urinary tract consists of several structures namely urethra, ureters, bladder and the kidneys. When any of these gets infected by minute organisms called bacteria, the result is bacterial Urinary Tract Infection (UTI). [1]

Types

Bacterial UTI can be divided into three major categories depending on which structure is involved. Infection of the urethra causes urethritis. When bacteria ascend to the bladder, UTI is known as ascystitis. Finally when it is the kidney that is affected, it is termed pyelonephritis. [2]

Epidemiology

UTI is a common medical concern accounting for approximately 8.1 million clinic visits annually. [3] 80% of these cases are actually caused by the bacterial strain Escherichia coli. Bacterial UTI is also 50-fold more common in females than males among adults 20 to 50 years of age. [4] Beyond this age, the incidence increases with the female:male ratio decreasing since bacterial UTI can also involve the prostate in elderly males. [5]

Causes

Females usually get UTI when wiping from back to front during urination. [4] Bacteria easily get into the urinary tract since female urethra is shorter and straighter as compared to males. Being sexually active may also increase the chance of getting UTI, for instance, vaginal bacteria can be pushed up into the urethra which may go all the way up to the bladder. [2] Men also acquire UTI through sexual intercourse especially those with unprotected anal intercourse and uncircumcised penis. Risk factors include use of contraceptives, urinary instrumentation like catheterization, advanced age, diabetes, anatomic abnormalities, and poor bladder emptying. [5]

Signs and Symptoms

Persons affected may present mild symptoms or no symptoms at all. The infection can also be spontaneously cleared in 2-5 days. Symptoms depend on age, gender and location of infection. Urethritis usually presents with pain or discomfort during urination with STD infections commonly causing a pus-like discharge. [1] Symptoms of cystitis are cloudy or bloody urine which may have foul odour, low fever (not always), pain on urination, lower mid-abdominal cramps and urinary urgency. Pyelonephritis usually causes chills, night sweats, fever >101 degrees Fahrenheit, nausea and vomiting, flushed skin, and pain inthe flanks, back or groin.[6]

Diagnosis

After getting the medical history and physical examination, urinalysis is done. Other tests may also be requested such as urine cultures, kidney and bladder ultrasound, complete blood count (CBC) andother specialized laboratory tests. [5]

Treatment

Bacterial UTI needs antibiotics for treatment. Surgery may be done when necessary. [5]

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Vitamin A [1, 19, 20, 21, 22, 23, 24, 25]:

Please note, this management does NOT treat the condition itself. It may mildly help in preventing some of the symptoms, and even then has insufficient evidence to back up this claim at present. Please note, this acts as a PREVENTATIVE treatment, and not necessarily symptomatic relief.

Recommendation: Strongly in favor (Vitamin A may help to prevent urinary tract infections due to its role in the body's immune function)

Grade of Evidence: high quality of evidence

Gotu Kola (Centella Asiatica, Hydrocotyle Asiatica) [1, 13, 14, 15, 16, 17, 18]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is insufficient evidence to support claims that Gotu Kola helps in the treatment of Bacterial Urinary Tract Infections in any way. More research is needed.)

Grade of Evidence: low quality of evidence

Goldenseal (Hydrastis Canadensis) [1, 5, 7, 8, 9, 10, 11, 12]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly against (There is insufficient evidence to support claims that Goldenseal helps to treat Urinary Tract Infections. More studies are needed. Goldenseal may produce toxic effects, including depression, constipation, rapid heartbeat, stomach pain, mouth ulcers and vomiting.)

Grade of Evidence: low quality of evidence

Echinacea Purpurea [1, 2, 3, 4, 5]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation  (Evidence has shown that Echinacea has no effect in the treatment or prevention of urinary tract infections)

Grade of Evidence: moderate quality of evidence

* www.gradeworkinggroup.org

References:

1. http://www.medicinenet.com/urine_infection/article.htm

2. http://kidshealth.org/teen/sexual_health/stds/uti.html

3. http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/

4.http://www.umm.edu/patiented/articles/what_infectious_agents_that_cause_urinary_tract_infections__000036_2.htm

5.http://www.merckmanuals.com/professional/genitourinary_disorders/urinary_tract_infections_uti/bacterial_urinary_tract_infections.html

6. http://health.nytimes.com/health/guides/disease/urinary-tract-infection/overview.html

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/echinacea

3. http://nccam.nih.gov/health/echinacea/ataglance.htm

4. http://www.ncbi.nlm.nih.gov/pubmed/16049208

5. http://www.medicalnewstoday.com/articles/29145.php

6. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/goldenseal

7. http://nccam.nih.gov/health/goldenseal/

8. Tierra Michael (1998): The Way of Herbs. New York, Pocket Books

9. Grieve M. (1971): A Modern Herbal. New York, Dover Publications, Inc

10. Mills S. and Bone K. (2000): Principles and Practice of Phytotherapy. Philadelphia, Churchill Livingstone

11. Tice Raymond (1997): Goldenseal and Two of its constituent alkaloids: berberine and hydrastine Research Triangle Park, National Institute of Environmental Health Sciences, in Seiger E: Review of Toxilogical Literature

12. http://www.henriettesherbal.com/eclectic/ellingwood/hydrastis.html

13. Winston, D., Maimes, S., Adaptogens: Herbs For Strength, Stamina, and Stress Relief, 2007, pp. 226-7

14. "A Double-Blind, Placebo-Controlled Study on the Effects of Gotu Kola (Centella asiatica) on Acoustic Startle Response in Healthy Subjects". Journal of Clinical Psychopharmacology. 20(6):680-684, December 2000. Bradwejn, Jacques MD, FRCPC *; Zhou, Yueping MD, PhD ++; Koszycki, Diana PhD *; Shlik, Jakov MD, PhD

15.  B. M. Hausen (1993) "Centella asiatica (Indian pennywort), an effective therapeutic but a weak sensitizer." Contact Dermatitis 29 (4), 175–179 doi:10.1111/j.1600-0536.1993.tb03532.x

16. Cataldo, A., Gasbarro, V., et al., "Effectiveness of the Combination of Alpha Tocopherol, Rutin, Melilotus, and Centella asiatica in The Treatment of Patients With Chronic Venous Insufficiency", Minerva Cardioangiology, 2001, Apr; 49(2):159-63

17. http://en.wikipedia.org/wiki/Gotu_kola#Medicinal_effects

18. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/gotu-kola

19. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-vitamina.html

20. http://www.nlm.nih.gov/medlineplus/vitamina.html

21. http://ods.od.nih.gov/factsheets/vitamina.asp

22. http://www.who.int/nutrition/topics/vad/en/

23. Latham, Michael E. (1997). Human Nutrition in the Developing World (Fao Food and Nutrition Paper). Food & Agriculture Organization of the United. ISBN 92-5-103818-X.

24. Sommer, Alfred (1995). Vitamin a Deficiency and Its Consequences: A Field Guide to Detection and Control. Geneva: World Health Organization. ISBN 92-4-154478-3.

25. http://www.unicef.org/worldfitforchildren/files/A-RES-S27-2E.pdf