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2000
Volume 31, Issue 39
  • ISSN: 1381-6128
  • E-ISSN: 1873-4286

Abstract

Background

Urinary tract infection (UTI) is a common infection, particularly among reproductive-age and elderly women. While antibiotics remain the primary treatment, antimicrobial resistance is a growing global concern, necessitating effective non-antibiotic alternatives.

Objectives

This study determines the safety and efficacy of herbal formulation compared to nitrofurantoin in treating uncomplicated UTI and its impact on health-related quality of life (HRQoL) in women.

Methodology

A randomized, standard-controlled study was conducted involving 66 women diagnosed with uUTI. Participants were randomly assigned to either the Unani Herbal Formulations group (UHF) or the nitrofurantoin group (NG). The UHF group (n=33) received a Unani herbal formulation (3.5 g powder of L., , L., L., and L.) along with 25 ml of L. syrup, administered twice daily for 8 days. The NG (n=33) received nitrofurantoin (100 mg) twice daily for 7 days. The primary outcome was the Urinary Tract Infection Symptom Assessment (UTISA) questionnaire. The secondary outcomes were symptom severity, urine dipstick test, urine culture and sensitivity, SF-12 HRQoL survey, and safety evaluation. Standardization, , and phytochemical analyses of the herbal formulation were also conducted.

Results

UTISA scores significantly improved within both groups ( < 0.001). The UTISA total score from 14.21 ± 3.43 and 14.18 ± 3.36 was reduced to 3.12 ± 4.65 and 1.61 ± 3.10 in the UHF and NG, respectively, on the 9th day. On the 9th day, 81.81% (UHF) and 87.87% (NG) had negative cultures. HRQoL scores showed significant within-group improvements ( < 0.001), with no significant difference between groups ( > 0.05). No adverse effects were reported. HPLC analysis confirmed the presence of Luteolin, a bioactive antimicrobial metabolite.

Conclusion

The herbal formulations were as effective as nitrofurantoin in treating bacterial uUTIs, with no adverse effects and enhanced HRQoL. The presence of Luteolin supports its antimicrobial potential, offering a favourable non-antibiotic alternative for UTI management.

Trial Registration

The research project is registered at the Clinical Trial Registry of India, ICMR with No: CTRI/2021/09/036138 dated 01/09/2021. The protocol can be retrieved from CTRI.

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References

  1. NajarM.S. SaldanhaC.L. BandayK.A. Approach to urinary tract infections.Indian J. Nephrol.200919412913910.4103/0971‑4065.59333 20535247
    [Google Scholar]
  2. GamaC.R.B. PomboM.A.G. NunesC.P. Treatment of recurrent urinary tract infection symptoms with urinary antiseptics containing methenamine and methylene blue: Analysis of etiology and treatment outcomes.Res. Rep. Urol.20201263964910.2147/RRU.S279060 33365282
    [Google Scholar]
  3. ChangS.J. LinC.D. HsiehC.H. LiuY.B. ChiangI.N. YangS.S.D. Reliability and validity of a Chinese version of urinary tract infection symptom assessment questionnaire.Int. Braz J Urol201541472973810.1590/S1677‑5538.IBJU.2014.0046 26401866
    [Google Scholar]
  4. GágyorI. RentzschK. Strube-PlaschkeS. HimmelW. Psychometric properties of a self-assessment questionnaire concerning symptoms and impairment in urinary tract infections: The UTI-SIQ-8.BMJ Open2021112e04332810.1136/bmjopen‑2020‑043328 33589460
    [Google Scholar]
  5. RazR. Urinary tract infection in postmenopausal women.Korean J. Urol.2011521280180810.4111/kju.2011.52.12.801 22216390
    [Google Scholar]
  6. CarJ. Urinary tract infections in women: Diagnosis and management in primary care.BMJ20063327533949710.1136/bmj.332.7533.94 16410583
    [Google Scholar]
  7. FlowerA. WangL.Q. LewithG. LiuJ.P. LiQ. Chinese herbal medicine for treating recurrent urinary tract infections in women.Cochrane Libr.201520176CD01044610.1002/14651858.CD010446.pub2 26040964
    [Google Scholar]
  8. GeorgeC. NormanG. RamanaG.V. MukherjeeD. RaoT. Treatment of uncomplicated symptomatic urinary tract infections: Resistance patterns and misuse of antibiotics.J. Family Med. Prim. Care20154341642110.4103/2249‑4863.161342 26288784
    [Google Scholar]
  9. DarvishiM. NouriM. RahimiR. Heidari-SoureshjaniS. Hashemi RafsanjaniS.M.R. A systematic review of the impact of resveratrol on viral hepatitis and chronic viral hepatitis-related hepatocellular carcinoma.Curr. Mol. Med.20242410.2174/0115665240284347240125072555 38375839
    [Google Scholar]
  10. VahlensieckW. LorenzH. Schumacher-StimpflA. FischerR. NaberK. Effect of a herbal therapy on clinical symptoms of acute lower uncomplicated urinary tract infections in women: Secondary analysis from a randomized controlled trial.Antibiotics20198425610.3390/antibiotics8040256 31817885
    [Google Scholar]
  11. LoneA.H. AhmadT. AnwarM. SofiG. Clinical efficacy and safety of a pharmacopial polyherbal Unani formulation in pityriasis versicolor: A comparative randomized single-blind study.J. Altern. Complement. Med.2012181097898210.1089/acm.2011.0520 22871048
    [Google Scholar]
  12. SiddiquiM.Y. AkhtarM.W. AzmatJ. A comparative clinical study of unani formulation (Maghz Tukhm-e-Jamun wa Tukhm-e-Hayat) and metformin in the management of Ziabetus Shakari (Type 2 Diabetes Mellitus).Med J Islam World Acad Sci201710.5505/ias.2017.37888
    [Google Scholar]
  13. KhanA. Haziq.Karachi: Madina citation1983
    [Google Scholar]
  14. KhanA. Iksir-i-A’zam.New DelhiIdarae Kitabus Shifa2011806808
    [Google Scholar]
  15. QamriM. Ghina Muna.New DelhiMarkazi Council Bara Tahiqeqate Tib Unani2008
    [Google Scholar]
  16. SharmaA. ChandrakerS. PatelV.K. RamtekeP. Antibacterial activity of medicinal plants against pathogens causing complicated urinary tract infections.Indian J. Pharm. Sci.200971213613910.4103/0250‑474X.54279 20336211
    [Google Scholar]
  17. GágyorI. HummersE. SchmiemannG. Herbal treatment with uva ursi extract versus fosfomycin in women with uncomplicated urinary tract infection in primary care: A randomized controlled trial.Clin. Microbiol. Infect.202127101441144710.1016/j.cmi.2021.05.032 34111592
    [Google Scholar]
  18. ArzaniA. Qarabadeen Qadri.New DelhiI’jaz Publishing House2009
    [Google Scholar]
  19. GhaniN. Khazainul Advia.New DelhiIdarae Kitabus Shifa2001Vol. I-IV
    [Google Scholar]
  20. TalatH. LatafatT. NaseerM. A ranomized open comparative clinical study of sharbat ustukhuddus and sharbat banafsha in the management of chronic rhinosinusitis.Indian J. Tradit. Knowl.202019218227
    [Google Scholar]
  21. BashirF. AkhtarJ. AnjumN. AlamS. Banafsha (Viola odorata L.), an important drug of Unani system of medicine with recent advances.Int J Unani Int Med202152737810.33545/2616454X.2021.v5.i2b.172
    [Google Scholar]
  22. KhareC.P. Indian Medicinal Plants: An illustrated Dictionary.New DelhiSpringer Berlin Heidelberg200710.1007/978‑0‑387‑70638‑2
    [Google Scholar]
  23. Al AkeelR. MateenA. AlharbiK.K. AlyousefA.A. Al-MandeelH.M. SyedR. Purification and MIC analysis of antimicrobial proteins from Cucumis sativus L. seeds.BMC Complement. Altern. Med.201818112110.1186/s12906‑018‑2176‑y 29615020
    [Google Scholar]
  24. GautamS.S. Navneet, Kumar S. The antibacterial and phytochemical aspects of Viola odorata Linn. Extracts against respiratory tract pathogens.Proc. Natl. Acad. Sci., India, Sect. B Biol. Sci.201282456757210.1007/s40011‑012‑0064‑7
    [Google Scholar]
  25. HabteG. TamiruS. EyasuK. In vivo antimalarial activity of the 80% methanolic crude fruit extract of Lagenaria siceraria (Molina) Standl. against Plasmodium berghei infected mice.Heliyon202394e1545310.1016/j.heliyon.2023.e15453 37151678
    [Google Scholar]
  26. PereiraR.S. SumitaT.C. FurlanM.R. JorgeA.O. UenoM. Antibacterial activity of essential oils on microorganisms isolated from urinary tract infection.Rev. Saude Publica200438232632810.1590/S0034‑89102004000200025 15122392
    [Google Scholar]
  27. RevathiB SasidharB BabuGR Evaluation of antibacterial activity of aqueous extract of Cucumis melo.Res J Pharm phytochem20231511410.52711/0975‑4385.2023.00001
    [Google Scholar]
  28. BodhankarS.L. TakawaleR.V. MaliV.R. KapaseC.U. Effect of Lagenaria siceraria fruit powder on sodium oxalate induced urolithiasis in Wistar rats.J. Ayurveda Integr. Med.201232757910.4103/0975‑9476.96522 22707863
    [Google Scholar]
  29. AhmedA. WadudA. JahanN. BilalA. HajeraS. Efficacy of Adiantum capillus veneris Linn in chemically induced urolithiasis in rats.J. Ethnopharmacol.2013146141141610.1016/j.jep.2013.01.011 23333749
    [Google Scholar]
  30. NishatA. SultanaS. SultanaA. A comparative study of polyherbal Unani formulations in gestational urinary tract infections.J. Exp. Integr. Med.201771110.5455/jeim.290117.or.166
    [Google Scholar]
  31. AlirezaeiA. Karimi ToudeshkiK. NouriS.B. The effects of Portulaca oleracea extract on 24-hour urine indices in patients with renal stone: A double-blind randomized placebo-controlled clinical trial.J. Renal Inj. Prev.2023124e3224010.34172/jrip.2023.32240
    [Google Scholar]
  32. ClaysonD. WildD. DollH. KeatingK. GondekK. Validation of a patient‐administered questionnaire to measure the severity and bothersomeness of lower urinary tract symptoms in uncomplicated urinary tract infection (UTI): The UTI Symptom Assessment questionnaire.BJU Int.200596335035910.1111/j.1464‑410X.2005.05630.x 16042729
    [Google Scholar]
  33. Kabir al-DinM. QarabadeenA. New Delhi: Central Council for Research in Unani Medicine.CCRUM2006
    [Google Scholar]
  34. SohS.E. MorelloR. AytonD. Measurement properties of the 12-item short form health survey version 2 in Australians with lung cancer: A Rasch analysis.Health Qual. Life Outcomes202119115710.1186/s12955‑021‑01794‑w 34059079
    [Google Scholar]
  35. DevilléW.L.J.M. YzermansJ.C. van DuijnN.P. BezemerP.D. van der WindtD.A.W.M. BouterL.M. The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy.BMC Urol.200441410.1186/1471‑2490‑4‑4 15175113
    [Google Scholar]
  36. SchumannG CanaliasF JoergensenPJ KangD LessingerJ-M KlaukeR IFCC reference procedures for measurement of the catalytic concentrations of enzymes: Corrigendum, notes and useful advice.cclm2010485615621.10.1515/CCLM.2010.13720298135
    [Google Scholar]
  37. TietzN. RinkerA. ShawL. IFCC reference procedure for measurement of catalytic concentration of enzymes at 37°C. Part 9. Reference procedure for measurement of catalytic concentration of alkaline phosphatase.Clin. Chem. Lab. Med.20114914391446 21702699
    [Google Scholar]
  38. MoghtadaeiP. SardariF. EsmaeilianS. Comparison of Ceftriaxone plus weekly Azithromycin or daily ofloxacin for outpatient treatment of pelvic inflammatory disease: A randomized clinical trial.J. Family Reprod. Health200828793
    [Google Scholar]
  39. QayyumS. SultanaA. HeyatM.B.B. Therapeutic efficacy of a formulation prepared with Linum usitatissimum L., Plantago ovata Forssk., and honey on uncomplicated pelvic inflammatory disease analyzed with machine learning techniques.Pharmaceutics202315264310.3390/pharmaceutics15020643 36839965
    [Google Scholar]
  40. SaeediR. SultanaA. RahmanK. Belal Bin HeyatM. KamalM.A. IshawuM. Efficacy of Acacia nilotica Linn. Pod’s Sitz bath plus vaginal pessary in syndromic management of abnormal vaginal discharge: A randomized controlled trial.Evid. Based Complement. Alternat. Med.2022202211110.1155/2022/5769555 35664940
    [Google Scholar]
  41. CharanJ. BiswasT. How to calculate sample size for different study designs in medical research?Indian J. Psychol. Med.201335212112610.4103/0253‑7176.116232 24049221
    [Google Scholar]
  42. ZaatoutH. AlShaikhN. SallamS. HammodaH. Phytochemical and biological activities of Lagenaria siceraria: An overview.Egypt. J. Chem.2023661047949510.21608/ejchem.2023.182665.7373
    [Google Scholar]
  43. AvornJ. MonaneM. GurwitzJ.H. GlynnR.J. ChoodnovskiyI. LipsitzL.A. Reduction of bacteriuria and pyuria after ingestion of cranberry juice.JAMA19942711075175410.1001/jama.1994.03510340041031 8093138
    [Google Scholar]
  44. KontiokariT. SundqvistK. NuutinenM. PokkaT. KoskelaM. UhariM. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in.BMJ20013227302157110.1136/bmj.322.7302.1571 11431298
    [Google Scholar]
  45. AnjuP.C. A study to evaluate the efficacy of cranberry extract supplements in prevention of recurrent urinary tract infections in female patients.Int. J. Basic Clin. Pharmacol.20209185410.18203/2319‑2003.ijbcp20205122
    [Google Scholar]
  46. SaeedM. KhanM.S. AmirK. Lagenaria siceraria fruit: A review of its phytochemistry, pharmacology, and promising traditional uses.Front. Nutr.2022992736110.3389/fnut.2022.927361 36185670
    [Google Scholar]
  47. WahidM. SaqibF. AhmedahH.T. Cucumis sativus L. seeds ameliorate muscular spasm-induced gastrointestinal and respiratory disorders by simultaneously inhibiting calcium mediated signaling pathway.Pharmaceuticals20211411119710.3390/ph14111197 34832981
    [Google Scholar]
  48. DasS. Natural therapeutics for urinary tract infections: A review.Future J. Pharm. Sci.2020616410.1186/s43094‑020‑00086‑2 33215041
    [Google Scholar]
  49. ArseneM.M.J. ViktorovnaP.I. DavaresA.K.L. Urinary tract infections: Virulence factors, resistance to antibiotics, and management of uropathogenic bacteria with medicinal plants: A review.J. Appl. Pharm. Sci.202111711210.7324/JAPS.2021.110701
    [Google Scholar]
  50. InsanuM. RizaldyD. SilvianiV. Chemical compounds and pharmacological activities of cucumis genus.Biointerface Res. Appl. Chem.2022121324133410.33263/BRIAC121.13241334
    [Google Scholar]
  51. SaeediR. SultanaA. RahmanK. Ethnomedicinal uses nad pharmacological activities of different parts of Cucumus sativus Linn: An update.Int. J. Pharm. Sci. Res.20201115491556
    [Google Scholar]
  52. YunusaA.K. DandagoM.A. IbrahimS.M. AbdullahiN. RilwanA. BardeA. Total phenolic content and antioxidant capacity of different parts of cucumber (Cucumis sativus L.).Acta Univ. Cibiniensis Ser. E Food Technol.2018222132010.2478/aucft‑2018‑0008
    [Google Scholar]
  53. IshaqM.S. HussainM.M. Siddique AfridiM. In vitro phytochemical, antibacterial, and antifungal activities of leaf, stem, and root extracts of Adiantum capillus veneris.Sci World J201410.1155/2014/269793
    [Google Scholar]
  54. MahboubiA. KamalinejadM. AyatollahiA.M. BabaeianM. Total phenolic content and antibacterial activity of five plants of labiatae against four foodborne and some other bacteria.Iran. J. Pharm. Res.2014132559566 25237351
    [Google Scholar]
  55. BatihaG.E.S. TeneS.T. TeiboJ.O. The phytochemical profiling, pharmacological activities, and safety of Malva sylvestris: A review.Naunyn Schmiedebergs Arch. Pharmacol.2023396342144010.1007/s00210‑022‑02329‑w 36418467
    [Google Scholar]
  56. TleubayevaM.I. DatkhayevU.M. AlimzhanovaM. Component composition and antimicrobial activity of CO2 extract of Portulaca oleracea growing in the territory of Kazakhstan.Sci. World J202110.1155/2021/5434525
    [Google Scholar]
  57. KashariO. Antibacterial activity and phytochemical screening of calabash seed oil on clinical isolates from skin.Int J Adv Acad Res Sci2018424889849
    [Google Scholar]
  58. IsmailA.M. MauloodK. AL-Khesraji T. Flavonoid contents of Adiantum capillus-veneris L. growing in two different districts from Iraqi Kurdistan Northern Iraq.Egypt Acad J Biol Sci201782531
    [Google Scholar]
  59. López-LázaroM. Distribution and biological activities of the flavonoid luteolin.Mini Rev. Med. Chem.200991315910.2174/138955709787001712 19149659
    [Google Scholar]
  60. ZhouY.X. XinH.L. RahmanK. Portulaca oleracea L.: A review of phytochemistry and pharmacological effects.BioMed Res. Int.201510.1155/2015/925631
    [Google Scholar]
  61. WahidM. SaqibF. AkhtarS. AliA. TalleiT.E. Simal-GandaraJ. Mechanistic insights of Cucumis melo L. seeds for gastrointestinal muscle spasms through calcium signaling pathway-related gene regulation networks in WGCNA and in vitro, in vivo studies.Comput. Biol. Med.202315510659610.1016/j.compbiomed.2023.106596 36773554
    [Google Scholar]
  62. TerninkoII OnishchenkoUE FrolovaA Phenolic compounds Malva sylvestris by high performance liquid chromatography. PHARMA Innov - J Res201434650
    [Google Scholar]
  63. KariotiA. FurlanC. VincieriF.F. BiliaA.R. Analysis of the constituents and quality control of Viola odorata aqueous preparations by HPLC-DAD and HPLC-ESI-MS.Anal. Bioanal. Chem.201139941715172310.1007/s00216‑010‑4473‑2 21153584
    [Google Scholar]
  64. QianW. LiuM. FuY. Antimicrobial mechanism of luteolin against Staphylococcus aureus and Listeria monocytogenes and its antibiofilm properties.Microb. Pathog.202014210405610.1016/j.micpath.2020.104056 32058023
    [Google Scholar]
  65. HisanoM. BruschiniH. NicodemoA.C. SrougiM. Cranberries and lower urinary tract infection prevention.Clinics (São Paulo)201267666166710.6061/clinics/2012(06)18 22760907
    [Google Scholar]
  66. HicklingD.R. NittiV.W. Management of recurrent urinary tract infections in healthy adult women.Rev. Urol.20131524148 24082842
    [Google Scholar]
  67. TakahashiS. TakahashiS. HamasunaR. A randomized clinical trial to evaluate the preventive effect of cranberry juice (UR65) for patients with recurrent urinary tract infection.J. Infect. Chemother.201319111211710.1007/s10156‑012‑0467‑7 22961092
    [Google Scholar]
  68. SchmiemannG. KniehlE. GebhardtK. Diagnosis of urinary tract infection: A systematic overview.Dtsch. Arztebl.201010736136710.3238/arztebl.2010.0361
    [Google Scholar]
  69. InsanuM. KarimahH. PramastyaH. Phytochemical compounds and pharmacological activities of Vitis vinifera L.: An updated review.Biointerface Res. Appl. Chem.2021116138291384910.33263/BRIAC115.1382913849
    [Google Scholar]
  70. LeiX. LiJ. LiuB. ZhangN. LiuH. Separation and identification of four new compounds with antibacterial activity from Portulaca oleracea L.Molecules2015209163751638710.3390/molecules200916375 26378504
    [Google Scholar]
  71. SultanaA. RahmanK. Portulaca oleracea Linn: A global panacea with ethnomedicinal and pharmacological potential.Int. J. Pharm. Pharm. Sci.201353339
    [Google Scholar]
  72. AhmedA. JahanN. WadudA. Physicochemical and biological properties of Adiantum capillus- Veneris Linn: An important drug of Unani system of medicine.Int J Pharm Res201247075
    [Google Scholar]
  73. InanmdarW. SultanaA. MubeenU. RahmanK. Clinical efficacy of Trigonella foenum graecum (Fenugreek) and dry cupping therapy on intensity of pain in patients with primary dysmenorrhea.Chin. J. Integr. Med.20161810.1007/s11655‑016‑2259‑x 27225291
    [Google Scholar]
  74. VisuvanathanT. ThanL.T.L. StanslasJ. ChewS.Y. VellasamyS. Revisiting Trigonella foenum-graecum L.: Pharmacology and therapeutic potentialities.Plants20221111145010.3390/plants11111450 35684222
    [Google Scholar]
  75. SinghA. DhariwalS. NavneetD. Traditional uses, antimicrobial potential, pharmacological properties and phytochemistry of Viola odorata: A mini review.J Phytopharm20187110310510.31254/phyto.2018.7120
    [Google Scholar]
  76. KatochM. SinghA. SinghG. WazirP. KumarR. Phylogeny, antimicrobial, antioxidant and enzyme-producing potential of fungal endophytes found in Viola odorata.Ann. Microbiol.201767852954010.1007/s13213‑017‑1283‑1
    [Google Scholar]
  77. PayezA.P. DeldadehN. GhiasvandS.G. Evaluation and comparison of antimicrobial and anticancer effects of aqueous and ethanolic extracts of Viola odorata.Multidiscip Cancer Investig2022631610.30699/mci.6.3.607‑1
    [Google Scholar]
  78. Mullaİ RoqaiyaM Imran KhanM. Efficacy of Viola odorata flower decoction in chronic rhinosinusitis.Med J Islamic orld Acad Sci2019273778410.5505/ias.2019.08379
    [Google Scholar]
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