Kranz Jennifer, Lackner Julia, Künzel Ulrike, Wagenlehner Florian, Schmidt Stefanie
Department of Urology and Pediatric Urology, University Medical Center RWTH Aachen, Aachen, Germany; Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany; UroEvidence@German Urological Society, Berlin, Germany; Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Germany.
Dtsch Arztebl Int. 2022 May 20;119(20):353-360. doi: 10.3238/arztebl.m2022.0104.
Uncomplicated urinary tract infections are among the commonest bacterial infections. Because antibiotic resistance is on the rise, there is growing interest in alternative, non-antimicrobial treatment options. This systematic review presents the current evidence on phytotherapy for the treatment and prevention of recurrent uncomplicated cystitis.
A systematic search of the relevant literature from January 2011 to August 2021 was carried out in the MEDLINE, Embase, and Cochrane Library databases and in two clinical trial registries. The trials included in the present review are ran - domized controlled trials (RCTs) of phytotherapeutic agents as monotherapy or combination therapy, in comparison to placebo, no treatment, non-pharmacological treatment, or drug treatment without any phytotherapeutic component. Two of the authors independently selected the publications, extracted the data, and estimated the risk of bias using the Cochrane Risk of Bias Tool.
12 RCTs with a total of 1797 female patients were included. A trial of acute therapy with Chinese plant-based medicine revealed non-inferiority to antibiotic treatment. Six trials of prophylaxis with cranberry products yielded mixed results with regard to efficacy against recurrent urinary tract infections. A trial of Seidlitzia rosmarinus for the prevention of cystitis showed that its use was associated with a lower cystitis rate than placebo (at 6 months: 33 vs. 73%, p <0.001). In all trials but one, the risk of bias was unclear or high. No standardized assessment of adverse events was carried out.
Phytotherapeutic agents are an option for the treatment and prevention of recurrent cystitis in women. Given the heterogeneous state of the evidence on phytotherapy, no dependable recommendations can now be made for the clinical management of these patients with respect to phytotherapeutic agents.
单纯性尿路感染是最常见的细菌感染之一。由于抗生素耐药性不断上升，人们对替代性的非抗菌治疗方案的兴趣日益浓厚。本系统评价展示了当前关于植物疗法治疗和预防复发性单纯性膀胱炎的证据。
在MEDLINE、Embase和Cochrane图书馆数据库以及两个临床试验注册库中，对2011年1月至2021年8月的相关文献进行了系统检索。本评价纳入的试验为植物治疗药物作为单一疗法或联合疗法的随机对照试验（RCT），与安慰剂、不治疗、非药物治疗或无任何植物治疗成分的药物治疗进行比较。两位作者独立选择出版物、提取数据，并使用Cochrane偏倚风险工具评估偏倚风险。
纳入了12项RCT，共1797名女性患者。一项关于中国植物药急性治疗的试验显示，其疗效不劣于抗生素治疗。六项关于蔓越莓产品预防的试验在预防复发性尿路感染的疗效方面结果不一。一项关于迷迭香叶预防膀胱炎的试验表明，其使用与低于安慰剂的膀胱炎发生率相关（6个月时：33%对73%，p<0.001）。除一项试验外，所有试验的偏倚风险均不明确或较高。未对不良事件进行标准化评估。
植物治疗药物是治疗和预防女性复发性膀胱炎的一种选择。鉴于植物疗法证据的异质性，目前无法就这些患者使用植物治疗药物的临床管理提出可靠建议。
