Managing Urinary Tract Infections - The Role of Holistic Medicine

Urinary Tract Infections (UTIs) are a significant burden on global health, affecting millions of people each year and occurring in various forms such as cystitis, pyelonephritis, and urosepsis. The common symptoms include dysuria, repeated urge to urinate and sometimes fever, indicating a more severe infection¹. In India, 33.54% of the population experiences UTIs².

UTIs are more common in women, with 60% experiencing at least one in their lifetime, 30-40% facing recurrent infections³, and 11-26% of pregnant women affected at some point⁴. UTIs make up 12.9% of hospital-acquired infections and are more common in individuals with diabetes, with 9.4% experiencing recurrent infections⁵.

Urinary Tract Infections – Overview

Urinary tract infections (UTIs) are primarily caused by bacteria, especially uropathogenic Escherichia coli (E. coli). Other causative bacteria include Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus spp.⁶.

Urinary tract infections (UTIs) occur when uropathogenic bacteria, mainly from the gut, enter the urethra and colonize the urinary tract. Using adhesins, bacteria adhere to the bladder lining, preventing their removal during urination. If the immune response fails to fight the infection, the bacteria proliferate, releasing toxins that damage bladder tissue and may ascend to cause pyelonephritis. In severe cases, bacteria may enter the bloodstream, causing bacteremia and systemic infection, leading to fever, chills, and septicemia, requiring urgent medical care⁷.

UTI symptoms depend on the infection site. Lower UTIs (cystitis) cause dysuria, frequent urination, nocturia, and foul-smelling urine. Upper UTIs (pyelonephritis) involve severe flank pain, high fever, and dark urine. Early diagnosis and treatment are essential to prevent complications⁶.

The diagnostic tests for UTIs include urine culture, PCR-based methods (PCR, FISH, MALDI-TOF), ELISA, dipstick tests, real-time PCR, and lateral flow assays.

Clinical Spectrum of UTIs

UTIs are classified based on predisposing conditions and the nature of the event. Uncomplicated UTIs (uUTIs) occur in healthy individuals, while complicated UTIs (cUTIs) may involve risk factors like structural abnormalities or immunosuppression⁸. (Fig.1)

Recurrent urinary tract infections (UTIs) arise due to various risk factors, including low estrogen levels, diabetes, urinary incontinence, vaginal wall prolapse, and incomplete bladder emptying. Individuals with diabetes are at a higher risk due to weakened immunity, while urinary incontinence and vaginal wall prolapse may contribute to poor hygiene and inefficient bladder emptying, respectively, and this increases the likelihood of reinfection. Addressing these underlying conditions is crucial for preventing recurrence.

To reduce the risk of recurrent UTIs, it is important to maintain good personal hygiene, use clean toilets, and follow safe sexual practices. Although long-term antibiotics are commonly prescribed for high-risk individuals, the growing concern over antibiotic resistance has driven interest in alternative treatment options such as holistic remedies as a safer, more sustainable, and effective alternative. These natural solutions support urinary health, prevent bacterial adhesion, and enhance bladder function, offering a holistic approach in managing recurrent infections⁶.

UTIs - Treatment

UTI treatment depends on severity. Asymptomatic bacteriuria usually requires no treatment unless in immunocompromised, diabetic, or pregnant patients. Acute uncomplicated cystitis is treated with Fosfomycin, nitrofurantoin, or pivmecillinam, while resistant cases may need cephalosporins, fluoroquinolones, or β-lactams for 3-5 days, often with urinary alkalizers⁶.

Treatment of UTI Involving the Kidneys (Pyelonephritis): Oral fluoroquinolones (levofloxacin) or β-lactams are the first-line treatments. Complicated cases (diabetes, pregnancy, immunosuppression) require IV antibiotics. Resistant infections are treated with ceftazidime/tazobactam, while carbapenem-resistant strains are treated using newer drugs like imipenem, cefiderocol, or meropenem-vaborbactam for their enhanced activity against these highly resistant bacteria ⁷.

Management of Complicated UTIs (cUTIs): Initial treatment includes amoxicillin combined with aminoglycosides or second/third-generation cephalosporins (cefuroxime, cefotaxime, ceftriaxone) with aminoglycosides. For multidrug-resistant cases, ceftolozane/tazobactam, imipenem/cilastatin, and ceftazidime/avibactam are preferred to prevent complications⁶.

Challenges of UTI Treatment in India

Primary challenges include high antibiotic resistance among uropathogens, limited diagnostic access in rural areas, poor patient compliance, self-medication, and inadequate hygiene awareness, contributing to recurrent infections.

• Antibiotic use presents two main risks: direct adverse effects (e.g., hypersensitivity, renal failure from amikacin, rashes, nausea, vomiting) and microbiome disruption, leading to Clostridium difficile infections, pneumonia, and vaginitis, highlighting the importance of judicious antibiotic use¹⁰. Globally, UTIs are the fourth leading cause of antimicrobial resistance (AMR)-related deaths.

To prevent antibiotic resistance in UTIs, urine cultures should be prioritized to identify the causative bacteria and guide targeted therapy, avoiding unnecessary broad-spectrum antibiotics. Shorter treatment durations and non-antibiotic options, such as evidence-based herbal supplements or probiotics, may be used for recurrent UTIs based on patient factors and resistance patterns. Many consultants recommend urine alkalization alongside antibiotics to enhance efficacy, reduce pain, urination frequency, toxicity, and prevent crystalluria by maintaining normal urine pH¹⁰.

Medicinal Plants in Managing Recurrent UTIs

For recurrent UTIs, long-term low-dose antibiotics are commonly used for prevention but can lead to multidrug-resistant bacteria and higher treatment costs⁹. The rise of resistant uropathogens highlights the need for alternative non-antibiotic approaches. Several herbs have shown strong antimicrobial activity against common UTI-causing bacteria. Common medicinal plants with antimicrobial properties include:

• Tribulus terrestris is known to exhibit bactericidal effects on E. coli, P. aeruginosa, and S. aureus, and thereby help provide symptomatic relief in urinary tract infection¹¹.
• Asparagus racemosus helps alleviate suprapubic discomfort, has demonstrated reduction of pus and epithelial cells in urine, and reduces urination frequency¹².
• While Nymphea nouchali has been shown to inhibit the growth of E. coli¹³, Solanum xanthocarpum exhibited high sensitivity against K. pneumoniae and moderate sensitivity against Escherichia coli¹⁴ and Terminalia chebula inhibits biofilm formation in P. vulgaris, E. coli, P. aeruginosa, S. aureus, and S. flexneri species¹⁵.
• Hemidesmus indicus inhibits P. aeruginosa, K. pneumoniae, and S. aureus, reducing infection risk by inhibiting biofilm formation and preventing bacterial colonization thereby reducing the risk of recurrent infections¹⁶.
• With benefits backed by scientific evidences, these remedies provide a holistic approach to prevent recurrent UTIs, ensuring long-term urinary health while minimizing drug resistance. (Fig.2)

Considering Holistic Treatment Options for UTI Management

Today there are clinically proven pharmaceutical grade herbal formulations available for use alongside antibiotics to reduce UTI severity and manage cystitis and pyelonephritis¹⁷. Renalka is a herbal urinary alkalizer that lowers urine acidity, helping relieve UTI symptoms by reducing discomfort and potentially enhancing the effectiveness of antibiotics¹⁸. This herbal formulation contains Tribulus terrestris (Gokshura), Cyperus rotundus (Musta), Elettaria cardamomum (Sukshmaila) which possesses antibacterial and anti-inflammatory properties, and diuretic properties¹⁹. Hemidesmus indicus (Sariva) and Kshara parpati helps normalize urinary pH, providing urinary alkalization properties, while Asparagus racemosus (Shatavari) is known to increase urinary magensium, thereby preventing crstallization²⁰. Crataeva nurvala/crataeva magna (Varuna) has potent anti-inflammatory effects²¹, and Vetiveria zizanioides (Ushira) offers antibacterial, antifungal, and anti-inflammatory benefits²². Additionally, Trikatu (Piper nigrum, Piper longum, Zingiber officinale) is known to enhance drug bioavailability by promoting gastrointestinal absorption. Together, these ingredients support urinary tract health, helping keep infections under control and alleviating UTI symptoms naturally²³.

Management of UTIs With Renalka: Evidence

• Renalka, a herbal formulation containing various natural ingredients, has shown potential in the management of urinary tract infections.
• A clinical trial conducted by Dr Garg evaluated its safety and effectiveness, following a four-week treatment protocol involving 50 patients and providing valuable evidence of its therapeutic benefits.
• The study included 50 patients (23 males and 27 females) presenting with symptoms of cystitis, prostatitis, prostatic abscess, and pyelonephritis at the start of the trial. It aimed to assess symptom relief and disease progression following treatment with Renalka.
• Among the 36 patients diagnosed with cystitis, 83% experienced symptom relief, while 80% of those with chronic prostatitis showed improvement, demonstrating the formulation’s potential effectiveness in managing urinary tract conditions²⁴. Additionally, in the case of pyelonephritis, 33% of the patients showed improvement, while 1 patient presented with prostatic abscess showed no improvement. (Fig.3)

• This formulation also showed antibacterial effects against Klebsiella, Pseudomonas, and E. coli with no reported adverse effects, thus proving the clinical efficacy of Renalka.^24,25.
• This holistic approach helps restore urinary pH, soothe inflamed mucosa, and reduce the growth of common uropathogens, providing anti-inflammatory and analgesic benefits.
• Symptoms typically improve within 2-3 days, and its highly palatable taste and cost-effective formulation make it a safe alternative to excessive antibiotic use.
• Integrating this holistic medicine with conventional UTI treatments enhances patient outcomes while reducing antibiotic dependence²⁶.

In conclusion,

• UTIs are challenging to manage as they require long-term antibiotic use, increasing the risk of AMR, treatment failure, and severe complications like systemic infections.
• Renalka, a clinically proven herbal formulation with antibacterial, anti-inflammatory, urinary alkalization, and diuretic properties, relieves dysuria and frequent urination while restoring urinary pH. It is cost-effective, requires no dosage dilution, and when used with antibiotics in severe cases, it enhances recovery, while in mild infections, it reduces antibiotic dependence. Its alkalizing effect also prevents infection progression, supporting long-term UTI management.

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