How to Prevent Urinary Tract Infection Recurrence Without Antibiotics

A fresh approach using mannosides for the treatment of urinary tract infection caused by E.coli has the potential to prevent recurrence of the infection without the repeated need for antibiotics. A study indicating the same was published in Nature. Escherichia coli (E. coli) are common bacteria that spread through contaminated food and water. Many E coli residing in the digestive tract do not cause digestive problems but can spread from the anal region to the lower urinary tract resulting in symptoms of frequent urination, urgency to pass urine, and a burning sensation while passing urine. Urinary tract infections are more common and tend to be recurrent in women, due to the smaller length of the urethra in females. Recurrent and untreated infection can spread to and damage the kidneys, or increase the risk of premature deliveries in pregnant women.

Urinary tract infections are treated with urinary antiseptics and antibiotics. In the recent years, stress has been placed on the importance of using antibiotics only when needed, to prevent the development of resistance. Antibiotic resistance refers to the ineffectiveness of antibiotics due to incorrect use, for example, not completing the course of treatment, or using an antibiotic for a viral infection.

Alternatives to antibiotics for the treatment of urinary tract infection are the need of the hour. Researchers are now evaluating the use of certain molecules called mannosides to treat urinary tract infection. Mannosides are chemically related to mannose, molecules to which the bacteria attach and remain latched to the inner lining of the urinary tract.

The E. coli have projections called pili with which they attach to mannose receptors on the bladder cells and cause infection. When mannosides are administered, the bacteria attach to these similar molecules instead, and get flushed out when the person urinates.

An approach that uses mannosides has the potential to reduce the use of antibiotics. Advantages of using such an approach include the following:

• The lethal effect of antibiotics on normal gut bacteria is avoided. Normal gut bacteria keep harmful bacteria at bay and maintain digestive health
• Antibiotic resistance is avoided

The researchers tested the possible effect of mannosides in preventing recurrent urinary tract infection in mice. They hypothesized that if the E. coli population within the gut is reduced, the chances of recurrence of urinary tract infection could also reduce. They introduced E. coli into the bladder and the gut of mice. This was followed by three oral doses of mannoside. The researchers found that:

• The bacteria were almost completely eliminated from the urinary bladder
• The bacterial count in the gut was around a hundred times lesser than before the treatment, probably because the mannosides prevented the attachment of the bacteria to the gut cells
• The count of the normal bacteria in the gut that do not cause urinary infection was only minimally affected

Mannosides thus have a potential to not only treat a urinary tract infection but also prevent recurrence. More importantly, as a result of their mechanism of action, they could also eliminate antibiotic-resistant bacteria, without the need for stronger antibiotics, which are often associated with more side effects. Clinical trials should be able to confirm the possible benefits of this treatment in patients, especially women, with recurrent urinary tract infection.

Reference:

1. Spaulding CM et al. Selective depletion of uropathogenic E. coli from the gut by a FimH antagonist. Nature (2017); doi:10.1038/nature22972

Source-Medindia