Eschborn – Urinary tract infections (UTIs) are among the most common reasons for visiting a doctor1 and are responsible for a high proportion of antibiotic prescriptions2. “Because of the problem of resistance, antibiotics should only be used in clearly defined bacterial urinary tract infections for which there are no other treatment options,” says urologist PD Dr. Winfried Vahlensieck, Bad Nauheim. This applies above all to pyelonephritis or urosepsis, while effective alternatives to antibiotics are available for cystitis and the prevention of recurrence of frequently recurring urinary tract infections. As co-author of the S3 guideline “Epidemiology, diagnostics, therapy, prevention and management of uncomplicated, bacterial, community-acquired urinary tract infections in adult patients”, the urologist advocates the use of evidence-based phytopharmaceuticals such as the combination of nasturtium and horseradish for acute and recurrent urinary tract infections ( in ANGOCINE® Anti-infection N) before using antibiotics. As a result, disease-causing bacteria and symptoms of cystitis can be effectively combated and recurrences and resistance can be counteracted, explains the urologist. In the interview, Vahlensieck goes on to explain the special therapeutic value he attaches to mustard oils.
What are the challenges in treating UTIs?
“The worrying development of antibiotic resistance is increasingly leading to treatment failure and protracted and potentially threatening disease progression. In 2019, 1.27 million people died worldwide from infections with multidrug-resistant pathogens. Further collateral damage can be shifts in the microbiome, for example in the gastrointestinal, urinary or vaginal tract, which can promote the occurrence of chronic and inflammatory diseases such as obesity, diabetes mellitus, allergies, asthma and intolerances.”
Against this background, how do you assess the potential of herbal therapeutic approaches, such as mustard oils from nasturtium and horseradish?
“Mustard oils (isothiocyanates), such as in particular benzyl mustard oil, allyl mustard oil and 2-phenylethyl mustard oil from nasturtium and horseradish have a broad antimicrobial spectrum of action in the gram-positive and -negative range against clinically relevant pathogens of urinary tract infections. These include numerous multi-resistant problem germs such as Klebsiella spp., Proteus vulgaris, Pseudomonas aeruginosa and vancomycin-resistant enterococci.3,4 A synergistic effect of the individual substances can be observed. The antibacterial effect is based on several mechanisms of action (including changes in bacterial membrane properties and changes in bacterial communication), so that the development of resistance seems rather unlikely. A reduction in biofilm formation and biological activity in existing biofilms and a reduction in the intracellular penetration of bacteria as a source of renewed recurrences are also positive.5-8 Thus, the mustard oils block mechanisms that can be held directly responsible for frequently recurring UTIs and the development of resistance. In addition, they also have an anti-inflammatory effect9-11which leads to a more rapid resolution of the inflammatory reaction and the symptoms.”
What is the problem with recurring UTIs?
“Recurrent UTIs in women represent a particular burden for the individual patient because of the recurring symptoms. In addition, numerous working hours are lost, so that there is also an economic problem. Although there is a very effective therapeutic measure with the low-dose antibiotic long-term prophylaxis. However, collateral damage such as the increasing development of resistance and changes in the microbiome must also be taken into account in long-term antibiotic prophylaxis. In addition to hormone substitution in the postmenopause, adhesion inhibition and immunization, multimodal phytotherapeutic therapy approaches are to be preferred in recurrent UTIs. In particular, the combination of mustard oils from nasturtium and horseradish root has a positive prospective, randomized, placebo-controlled, blinded study12 received a positive recommendation in the guideline on uncomplicated UTIs from 2017 (evidence level Ib, recommendation level C1). The use of the mustard oil combination as a supportive measure for uncomplicated recurrent cystitis in late childhood and adolescence is also recommended in the S2k guideline “UTI in childhood”.13.“
Do you also support the use of mustard oils in acute therapy and if so, why?
“Yes, even in the treatment of uncomplicated cystitis, preference should be given to non-antibiotic therapeutic approaches. There are effective therapy options in the field of phytotherapy. The mustard oil combination of nasturtium and horseradish, for example, has been used to treat acute urinary tract infections for over 60 years. Studies also confirm the effectiveness14,15, so that I support the use of uncomplicated cystitis before the use of antibiotics. In order to avoid an increased occurrence of pyelonephritis, the antibacterial effect should be the priority when choosing an alternative herbal drug and a therapy with only painkilling, flushing or anti-adhesive effects should be carefully considered.”
Editorial note: gender-neutral wording
The gender-specific spelling is not used in this press release solely for better readability. All personal formulations in this text are therefore to be interpreted as gender-neutral.
ANGOCIN® Anti-infection N
Application areas: To improve the symptoms of acute inflammatory diseases of the bronchi, sinuses and urinary tract. Composition: 1 film-coated tablet contains: Nasturtium herb 200 mg, horseradish root 80 mg. Other ingredients: cellulose, iron oxides and hydroxides E 172, hypromellose, potato starch, macrogol, sodium carboxymethyl starch, colloidal anhydrous silicon dioxide, stearic acid, talc, titanium dioxide E 171. Contraindications: Acute stomach and intestinal ulcers and/or acute kidney inflammation, allergy to nasturtium herb, horseradish root or any of the other ingredients. Side effects: Common: Stomach and intestinal problems such as nausea, upper abdominal pressure, diarrhea, flatulence or heartburn. Occasionally: Systemic allergic reactions and skin hypersensitivity reactions (e.g. flushing, rash and/or itching). Pharmaceutic entrepreneur: Repha GmbH Biological Drugs, Alt-Godshorn 87, 30855 Langenhagen.
Sources 1-15 can be requested from the following press contact: