Phytotherapy in catheter-associated urinary tract infection. Observational study recording the efficacy and safety of a fixed herbal combination containing Tropaeolimajoris herba and Armoraciae rusticanae radix

Background. The rate of infections occurring during hospitalization is increasing. Urinary tract infections (UTIs) comprise the majority of cases (40%), many of which are catheter-associated. Antibiotic resistance due to antibiotic misuse and overuse exacerbates this situation. Alternative therapies are consequently becoming more important in daily clinical practice. One of the few approved alternatives for the treatment of UTIs is Angocin (R), a herbal medicinal product containing nasturtium and horseradish powder. Objectives. Evaluate the efficacy and safety of Angocin (R) in adult patients with catheter-associated UTIs. Materials and methods. Ninety-six inpatients with catheter-associated UTI successfully completed a 3-arm, 5-week observational study. Three patient groups were assessed: 1) monotherapy with Angocin (R) (Repha GmbH, Langenhagen, Germany) (42%), 2) Angocin (R) as an add-on to antibiotic therapy (29%), and 3) antibiotic therapy alone (29%). Outcome measures included: pathogen number and resistance spectrum in the urine, inflammation markers in the blood, antibiotic use, adverse events (AE), adverse drug reaction (ADR), efficacy, and tolerability. Results. One-hundred percent of initial UTIs were healed with add-on therapy and pure antibiotic therapy after an average of 10.5 and 9 days, respectively. The Angocin (R) monotherapy led to a successful treatment rate of 46% after an average of 28 days. Dosages of Angocin (R) with 3x4 or 3x3tablets per day were markedly below the recommended upper dosage level. The recurrence rate of UTI was markedly reduced with Angocin (R) mono- and add-on therapies (both 50%) in contrast to pure antibiotic therapy (79.3%). The incidence of AEs and ADRs in the Angocin (R) monotherapy group (23.8%) was also lower than that reported in the add-on therapy group (44.8%) and pure antibiotic group (34.5%). Conclusion. Mono- and add-on therapies using the herbal medicinal product Angocin (R) substantially reduced the recurrence of catheter-associated UTIs in comparison to antibiotic therapy alone. This results in a potential prophylactic efficacy by Angocin (R) which may represent a promising alternative for the treatment and prevention of recurrent catheter-associated UTIs, reducing antibiotic use. Further clinical trials are warranted to confirm these findings.