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Saturday, August 27, 2016

Efficient and Cost-Effective Alternative Treatment for Recurrent Urinary Tract Infections and Interstitial Cystitis in Women

Case  1
A 28-year-old female presents with a history of rUTI, which started at the age of 11. She suffered symptoms of severe constipation that she treated with herbal laxatives. She experienced episodes of fatigue, pubic pain, loss of appetite, malaise, dysuria, polyuria, urinary incontinence, and macroscopic hematuria. The frequency and severity of the symptoms increased with age, and its recurrence has shifted from occurring once every year to once every 2-3 months after she started having regular sexual intercourse. In addition, she suffered from dyspareunia and urgent urination that were aggravated after tampons usage. Pelvic ultrasound did not show any renal calculi or bladder enlargement, yet it revealed signs of interstitial cystitis.

Different antibiotics were given for treatment including ciprofloxacin (500 mg b.i.d), ofloxacin (200 mg b.i.d) or norfloxacin (400 mg b.i.d), cefuroxime (500 mg b.i.d), or amoxicillin/clavulanic acid (1 g b.i.d). Resistance was developed to these drugs and others were given aiming to prevent the recurrence such as nitrofurantoin (100 mg bid) and fosfomycin (3 g/day), to which she was sensitive. However, the symptoms of interstitial cystitis persisted despite the antibiotic therapy and the patient developed candidiasis that was resolved with fluconazole (150 mg) taken every 5 days after starting antibiotic treatment. Yet the patient became nonresponsive to fluconazole, which was substituted with itraconazole (100 mg bid every 2 days).

One year ago, she started an alternative medical treatment that included simultaneous intake of cranberry tablets (containing 700 mg cranberry extract conc Tit 1%, intake of proanthocyanidin 7 mg, grapefruit seeds dry extract 4/1 100 mg, Orthosiphon titrated dry extract 0.2% 100 mg, intake of sinensetin 0.2 mg, and goldenrod titrated dry extract 10/1 100 mg), probiotics (containing vitamin B1 0.42 mg, vitamin B2 0.48 mg, vitamin B6 0.6 mg, niacin 5.4 mg, vitamin B5 1.8 mg, vitamin B12 0.3 μg, and total milk enzymes: L. rhamnosus, L. acidophilus, Streptococcus thermophilus, Bifidobacterium bifidum, and L. bulgaricus, living cells not less than 2 billion), L-arginine (2 tablets/day, arginine hydrochloride 1000 mg in one serving capsule), and 1 tablet of magnesium at night (magnesium oxide 300 mg in each serving capsule). Following this regimen, the frequency and urgency to urinate decreased and UTI recurred after 2 month. Afterwards, she started taking garlic softgel tablets (serving size 2 softgels: garlic oil 4.6 mg, 500 : 1 concentrate equal to 2300 mg fresh garlic) and parsley seed oil tablets (110 μg, 2000 : 1 concentrate equal to 220 mg fresh parsley). These have shown a decrease in the UTI recurrence to 6-7 months and eventually no recurrence was recorded for the last 12 months. Moreover, the severity of recurrence has decreased and response to antibiotics has become more pronounced. Later when she discontinued garlic intake and became noncompliant to this treatment, UTI reappeared after 2 months.

Case  2
A 28-year-old female presented with the history of rUTI since the age of 23. The patient's symptoms include burning sensations in the lower area with stabbing-like pain, urgency, and dysuria followed by hesitancy. The patient also reported a high frequency of urination, reaching 10 times/hr. In her first recurrent episode, urinalysis revealed pyuria (8–10 WBCs/hpf) and positive nitrites test and E. coli culture. Then, ciprofloxacin was prescribed (500 mg bid for 5 days) and she experienced 2-3 recurrence episodes with positive E. coli cultures. Later on, resistance to ciprofloxacin was developed with pelvic echogram and cystoscopy not showing any abnormality, while urinalysis showed persistent bacteriuria and cultures of E. coli resistant to fluoroquinolones.

Along with recurrent UTI over the years, interstitial cystitis also started in addition to chronic daily symptoms of overreactive bladder, urgency, frequency, and pubic pain. Nitrofurantoin (2 tablets/day) was prescribed along with fluvoxamine (1 tablet t.i.d.) to alleviate symptoms of overreactive bladder. Her previous history included no sexual activity for the last 4 years, persistent constipation, healthy diet and lifestyle, inadequate water intake, and the use of intimate perfumed washing gel fragranced, panty-liners and synthetic polyester lingerie, and back to front wiping hygiene.

With time the patient entered a depression due to the rUTI with persistent E. coli cultures and the chronic interstitial cystitis that remained untreatable. An alternative treatment regimen was prescribed and it included cranberry tablets (1 tablet t.i.d.), probiotics (1 tablet before breakfast and dinner), garlic and parsley (6 tablets at night), magnesium tablets (2 tablets 300 mg each at night), evening primrose oil (2 tablets after lunch), and L-arginine (500 mg, 1 tablet t.i.d.). Several weeks following this regimen, the patient's symptoms including an overreactive bladder diminished, and urgency, frequency, and pubic pain decreased by 80%. Cultures remained negative and the patient experienced only one interstitial cystitis episode, which was alleviated with L-arginine (1000 mg), magnesium tablets, and sustained hydration.


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