Antibiotics or NSAIDs for uncomplicated urinary tract infection?

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5037 (Published 08 November 2017) Cite this as: BMJ 2017;359:j5037

Alternative strategists in the management of Urinary tract infections.

Urinary tract infections (UTIs) are most commonly observed in young females who are pregnant. Its prevalence is higer in females due to various causes like short urethra, pregnancy, etc. UTIs are often treated with NSAIDs and Antibiotics. Generally, a Holistic approach is needed due to potential antibiotic resistance and other issues.

1. Herbal management: Boerhavia diffusa (1), (2), Dolicos Biflorus (3), Berginia ligulata (4), Tribulus terrestris (5), etc., are delivering promising results in the management of UTIs and associated symptoms and complications.
2. Use of potassium salts instead of Common or Sodium salts is useful in alkalinizing the urine (6).
3. Proper Counselling or moral support in case of UTIs due to Sexual intercourse (7).
4. Cost compatibility can be achieved by adopting various methods: using proper vaccination (8), avoiding unnecessary investigation, and medication (9).

In case of UTIs, we must follow the proper set of ideology which will deliver better cost compatible effective health care. This includes proper diagnosis in an asymptomatic woman, proper urine culture, duration of antimicrobial therapy, other causes like diabetes in women, Age, Spinal cord injury, Catheterized patients, etc. (10). In this way we can deliver proper health care to the affected UTI population.

1. Sharma, Anjana, Rani Verma, and Padmini Ramteke. "Antibacterial activity of some medicinal plants used by tribals against UTI causing pathogens." World Applied Sciences Journal 7.3 (2009): 332-339.

2. Prachi, Chauhan N., D. Kumar, and M. S. Kasana. "Medicinal plants of Muzaffarnagar district used in treatment of urinary tract and kidney stones." Indian journal of traditional knowledge 8.2 (2009): 191-195.

3. Chitme, Havagiray R., et al. "Herbal treatment for urinary stones." International Journal of Pharmaceutical Sciences and Research 1 (2010): 25-31.

4. Tambekar, D. H., S. B. Dahikar, and S. B. Dahikar. "Antibacterial potential of some herbal preparation: An alternative medicine in treatment of enteric bacterial infection." Int J Pha Pharm Sci 2.4 (2010): 176.

5 .Chitme, Havagiray R., et al. "Herbal treatment for urinary stones." International Journal of Pharmaceutical Sciences and Research 1 (2010): 25-31.

6. Head KA. Natural approaches to prevention and treatment of infections of the lower urinary tract. Alternative Medicine Review. 2008 Sep 1;13(3):227-45.

7. Leibovici, L. Int Urogynecol J (1991) 2: 105.

8. Foxman B, Barlow R, D'Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Annals of epidemiology. 2000 Nov 30;10(8):509-15.

9. Fenwick EA, Briggs AH, Hawke CI. Management of urinary tract infection in general practice: a cost-effectiveness analysis. Br J Gen Pract. 2000 Aug 1;50(457):635-9.

10. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clinical Infectious Diseases. 2005 Mar 1:643-54.

Competing interests: No competing interests

06 December 2017
Kamath Madhusudhana
Associate Professor
Division of Ayurveda, Center for Integrative Medicine and Research (CIMR) Manipal University, Manipal