Efficacy of combined antibacterial-prebiotic therapy in combination with D-mannose in women with uncomplicated lower urinary tract infection


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Abstract

Introduction. Acute cystitis is the most common manifestation of uncomplicated urinary tract infection. One of the drugs whose effectiveness in the treatment of patients with INMP has been proven is fosfomycin, which has been on the pharmaceutical market for a long time and is widely used in urological practice. despite the good results of etiotropic therapy, the problem of recurrent UTI remains unresolved, which occurs in about 30% of women within a year after the first episode of cystitis. alternative prophylactic agents, such as probiotics, cranberry preparations, phytopreparations, etc. are increasingly used in prolongation of the inter-relapse period. One such remedy is D-mannose. Objective: to evaluate the effectiveness ofD-mannose and the combined drug Ecofomural containing fosfomycin and lactulose in the complex treatment of women with uncomplicated lower urinary tract infection. Materials and methods. 60 women with acute uncomplicated cystitis were examined and treated. By random sampling, all women were divided into 2 groups of 30 people. In group 1, antibiotic therapy with Ecofomural once 1 sachet after urination was prescribed. The product contains 3G of fosfomycin and 1.5 g of prebiotic lactulose. In group 2, a similar antibacterial therapy with the enrichment of the diet with a source of D-mannose (Ecocystin) 1 sachet 1 time per day for 6 months. Evaluation of the effectiveness of antibacterial therapy was carried out on the 3rd and 7th day. It included analysis of dysuric symptoms according to diaries of urination, assessment of pain intensity, laboratory tests. Long-term results of therapy were evaluated within 6 months after taking the antibacterial drug. The examination included a comparative analysis of the frequency of relapses of the disease, filling diaries of urination and laboratory tests. Results. When treated, all women showed signs of acute cystitis. On the 3rd day of therapy in both groups there was a statistically significant (p<0.05) positive dynamics of the studied parameters. By the 7th day in both groups marked relief of dysuric phenomena and pain. The number of white blood cells in the urine of all patients was within normal values. During a further 6-month follow-up, relapses of the disease were detected in 7 (23.3%) patients in group 1 and in 1 (3.3%) in group 2. Bacteriological examination in group 1 revealed the same pathogen in 5 (16.7%) cases as in the first treatment. The other women had different pathogens. Conclusion. The results of the study demonstrated the high efficacy and safety of complex therapy with Ecofomural containing fosfomycin and lactulose, in combination with long-term enrichment of the diet with D-mannose (Ecocystin) b in order to prolong the inter-relapse period of uncomplicated lower urinary tract infection.

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About the authors

A. V Kuzmenko

Voronezh State Medical University n.a. N.N. Burdenko

Email: Kuzmenkoav09@yandex.ru
MD, associate professor, Head of Department of Urology Voronezh, Russia

V. V Kuzmenko

Voronezh State Medical University n.a. N.N. Burdenko

Email: kuzmenkovv2003@mail.ru
MD, professor at the Department of Urology Voronezh, Russia

T. A Gyaurgiev

Voronezh State Medical University n.a. N.N. Burdenko

Email: tima001100@mail.ru
Ph.D., associate professor at the Department of Urology Voronezh, Russia

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