Abstract
Background: Recurrent urinary tract infections (rUTI) are one of the most common bacterial infections and are responsible for a significant proportion of antimicrobial prescriptions. rUTI are caused by the invasion of the urinary tract by uropathogens from the genitourinary and gastrointestinal microbiome. Antimicrobial stewardship programmes aim to reduce the overuse and misuse of antimicrobials to limit the development of antimicrobial resistance and maintain the efficacy of antimicrobials for the treatment of disease. preventing rUTI and the associated antimicrobial use is a useful way to meet the principles of antimicrobial stewardship programmes. Complementary therapies may represent a non-pharmacological prophylaxis strategy against rUTI, reducing the associated burden of disease and use of antimicrobials. Evidence exists for the efficacy of cranberry products and other plant extract formulations for the prophylaxis against rUTI. However, current guidelines and recommendations do not recommend the use of these products for rUTI prophylaxis and instead recommend antimicrobial and behavioural prophylaxis despite the demonstrated risk of antimicrobial resistance and limited evidence into the efficacy of behavioural strategies for the prophylaxis of rUTI.
Aim: This review evaluates the evidence for cranberry and other plant extract formulations as non-pharmacological prophylaxis strategies against uncomplicated rUTI in women an attempt to reduce antimicrobial prescriptions and further the goals of antimicrobial stewardship.
Methodology and Methods: An integrative literature review of the current literature was carried out as per Whittemore and Knalf (2005). The methodology incorporated studies of diverse methodologies which were reviewed against inclusion and exclusion criteria informed by the study aim. Data was analysed using a constant comparison approach where data was grouped together to be compared and contrasted with the aim of drawing out relationships and patterns. The results were synthesised and compared to the primary research to ensure accurate representation and participant protection.
Findings: The search strategy resulted in a total of 11 studies being incorporated into the review, five RCTs, five observational trials and one cross-sectional survey. The results of the search strategy were displayed using the pRISMA scheme. The review population included 1,371 women, 896 who participated in cranberry studies and 313 who participated in other plant extract studies. primary studies were located in eight different countries and took place in a number of different clinical settings including hospitals, research centres and online. Three syntheses were developed from the data analysis; 1) a variety of cranberry products demonstrated efficacy as prophylaxis against rUTI, 2) a variety of other plant extracts demonstrated efficacy as prophylaxis against rUTI and 3) reduction in recurrence rates of rUTI resulted in an improvement in quality of life.
Discussion: This study presents evidence for the efficacy of cranberry and other plant extract formulations for the prophylaxis against rUTI. The use of these complementary therapies led to a reduction in the recurrence rate of rUTI, which in turn led to an improvement in the quality of life for the participants. Cranberry products and the plant extract formulations investigated in this review represent effective, non-pharmacological prophylaxis strategies against rUTI and therefore reduce the use of antimicrobials, thus achieving antimicrobial stewardship principles. Despite this evidence, current guidelines and recommendations for rUTI prophylaxis do not include the use of cranberry and other plant extract formulations and instead recommend antimicrobial and behavioural prophylaxis. It is likely that these recommendations will remain unchanged until more rigourous clinical data are produced illustrating the efficacy of these products as prophylaxis against rUTI.