Abstract
A healthy urinary tract contains a variety of microbes resulting in a diverse urobiome. Urobiome dysbiosis, defined as an imbalance in the microbial composition in the microenvironments along the urinary tract, is found in women with uncomplicated urinary tract infection (UTI). Historically, antibiotics have been used to address UTI. An alternative approach to uncomplicated UTI is warranted as the current paradigm fails to take urobiome dysbiosis into account and contributes to the communal problem of resistance. A whole-person, multi-modal approach that addresses vaginal and urinary tract dysbiosis may be more effective in reducing recurrent UTI. In this review, we discuss strategies that include reducing pathogenic bacteria while supporting commensal urogenital bacteria, encouraging diuresis, maintaining optimal pH levels, and reducing inflammation. Strategies for future research are suggested.
Highlights
Each year approximately 97 million outpatient visits are associated with antibiotic prescriptions, more of which are given for urinary tract infection (UTI) than any other diagnosis [1,2]
These findings suggest that some cases of “suspected UTI” could be symptomatic expressions of microbial dysbiosis, which might only be exacerbated by antibiotics
Arbutin is a glycoside derived from extracts of the leaves of Arctostaphylos uva-ursi, which has been used traditionally for the treatment of UTI in Europe, America, and Asia [72]. β-arbutin exhibits antimicrobial activity and has been shown to destroy a variety of both Gram-negative and Gram-positive bacteria including Staphylococcus aureus, Enterococcus faecalis, and Escherichia coli, as well as the antibiotic-resistant strains: Escherichia coli ESBL R194, Enterococcus faecalis HLAR, and S. aureus MRSA K31 [73,74]. β-arbutin has shown hepatic anti-inflammatory effects as well as restorative histopathological changes in the liver, pancreas, and kidneys damaged by diabetes in rats [75,76]
Summary
Each year approximately 97 million outpatient visits are associated with antibiotic prescriptions, more of which are given for urinary tract infection (UTI) than any other diagnosis [1,2]. Research has shown that antibiotic use is associated with an increased risk of recurrent UTI [4]. Exposure to fluoroquinolones has been associated with a more than 6-fold increased risk of acquiring C. difficile colitis [11]. This review applies a framework of WPH [12] to cystitis by examining the dynamic interactions between multiple organ systems and the microbiome that manifest as cystitis. We weave this holistic discussion of cystitis pathophysiology with the urgency of antibiotic resistance, amplifying the call for a new primary treatment strategy for uncomplicated cystitis.
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