HEALTH OF WOMAN. 2020.2(148): 30–37; doi 10.15574/HW.2020.148.30
 Budnik T. V.
Shupyk National Medical Academy of Postgraduate Education, Kiev

Prevalence of a patient with urologic symptoms at an outpatient doctor, pediatric nephrologist contributes to the hyperdiagnosis of urinary tract infection in children (UTI). At the same time, the lack of a clear patient stratification algorithm for the use of antibacterial drugs (ABD) leads to abuse and serious consequences.
The objective: study of the efficacy and safety of the use of standardized herbal medicine Canephron^®  N in children with urological symptoms without signs of systemic inflammatory reaction with the possibility of delayed administration of antibacterial therapy at the outpatient stage.
Materials and methods. The study included 50 children aged 12 to 18 years with characteristic urological symptoms without any signs of systemic inflammation (lack of hyperthermia and/or leukocytosis). The study was conducted with the informed consent of children and parents in accordance with the Declaration of Human Rights in Helsinki. Verification of diagnoses was performed according to the unified clinical protocol of the Ministry of Health of Ukraine No. 627 dated November 3, 2008. The delayed tactics for the appointment of ABD are based on the provisions of the national British guidance NICE, 2018 by urine analysis using a dipstick test.
Results. In 97% ± 2.8 (35/36) cases, the clinical and laboratory efficacy of the herbal remedy Canephron^® N was confirmed. On the 7th day of therapy, 100% of patients (p<0.05) showed a regression of dysuria, pain, and leukocyturia. The number of patients with bacteriuria was reduced by 1.8 times (40% ± 20.77 (14/36) vs 22% ± 30.99 (8/36); p<0.05). The powerful crystallolytic action of the drug was noted at an early date (the crystalluria level increased by 2.8 times at day 7 of therapy, p<0.05), however, it required the prolongation of the use of the drug Canephron^® N under the control of saline and ultrasound indicators.
The likelihood of delayed involvement in ABD phytotherapy was low and was OR=0.049±0.553 [0.017; 0.146]; p<0.05. The likelihood of recurrent UTI in the next 3 months after the 7-day course with Canephron^® N was minimal and was OR=0.001±1.434 at 95% CI [0.000; 0.014]; p<0.05.
Conclusions. The delayed tactics of ABD under the guise of the herbal remedy Canephron^® N was justified for girls aged 12–18 years with the stratification of the patient by dipstick test (88% ± 5.17 (44/50) showed negative nitrite test). The further prospect of such research in children is urgent and valid.
Key words: urological symptoms, urinary tract infection, children, phytotherapy, Canephron^® N.

REFERENCES

1. Jackson EC. 2015. Urinary tract infections in children: knowledge updates and a salute to the future. Elektronnyi resurs. Pediatrics in Review 36. https://doi.org/10.1542/pir.36-4-153; PMid:25834219

2. Finucane TE. 2017, Aug. «Urinary Tract Infection» – Requiem for a Heavyweight. J Am Geriatr Soc. 65(8):1650-1655. https://doi.org/10.1111/jgs.14907; PMid:28542707

3. Ventola CL. 2015. The antibiotic resistance crisis: part 1: causes and threats. Pharm Ther. 40:277–283. PMC free article. PubMed. Google Scholar.

4. Tandogdu Z, Cek M, Wagenlehner F, Naber K, Tenke P, van Ostrum E, Johansen TB. 2014. Resistance patterns of nosocomial urinary tract infections in urology departments: 8-year results of the global prevalence of infections in urology study. World J Urol. 32:791–801. PubMed. Google Scholar. https://doi.org/10.1007/s00345-013-1154-8; PMid:23979151

5. Hewitt IK, Pennesi M, Morello W et al. 2017. Antibiotic prophylaxis for urinary tract infection–related renal scarring: a systematic review. Elektronnyi resurs. Pediatrics 139. https://doi.org/10.1542/peds.2016-3145; PMid:28557737.

6. EAU Guidelines Edn presented at the EAU Annual Congress Copenhagen. 2018 ISBN 978-94-92671-01- http://www.//uroweb.org/guideline/urological-infections/  Google Scholar.

7. Bleidorn J, Hummers-Pradier E, Schmiemann G, Wiese B, Gagyor I. 2016. Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial. Ger Med Sci. 14 Doc01. PMC free article. PubMed. Google Scholar.

8. Langdon A, Crook N, Dantas G. 2016. The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation. Genome Med. 8:39. PMC free article. PubMed. Google Scholar. https://doi.org/10.1186/s13073-016-0294-z; PMid:27074706 PMCid:PMC4831151

9. Wullt B, Svanborg C. 2016. Deliberate establishment of asymptomatic bacteriuria – a novel strategy to prevent recurrent UTI. Pathogens. 5:52. PMC free article. PubMed. Google Scholar. https://doi.org/10.3390/pathogens5030052; PMid:27483325 PMCid:PMC5039432

10. Naber K, Steindl H, Abramov-Sommariva D, Eskoetter H. 2013. Non-antibiotic herbal therapy of uncomplicated lower urinary tract infection in women – a pilot study. Planta Med. 79:PB1. Google Scholar. https://doi.org/10.1055/s-0033-1351946

11. Kronenberg A, Butikofer L, Odutayo A, Muhlemann K, da Costa BR, Battaglia M, Meli DN, Frey P, Limacher A, Reichenbach S, Juni P. 2017. Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial. BMJ. 359:j4784. PMC free article. PubMed. Google Scholar. https://doi.org/10.1136/bmj.j4784; PMid:29113968 PMCid:PMC5672899

12. Stange R, Schneider B, Albrecht U, Mueller V, Schnitker J, Michalsen A. 2017. Results of a randomized, prospective, double-dummy, double-blind trial to compare efficacy and safety of a herbal combination containing Tropaeoli majoris herba and Armoraciae rusticanae radix with co-trimoxazole in patients with acute and uncomplicated cystitis. Res Rep Urol. 9:43–50. PMC free article. PubMed. Google Scholar. https://doi.org/10.2147/RRU.S121203; PMid:28352615 PMCid:PMC5359132

13. Loew D, Dieter D, Habs M, Klimm HD, Trunzler G, Erkrankungen der ableitenden Harnwege . Phytopharmaka-Report: Rationale Therapie mit pflanzlichen Arzneimitteln. In: Loew D, Habs M, Klimm H-D, Trunzler G, editors. Heidelberg: Steinkopff-Verlag Heidelberg; 2013. Google Scholar.

14. Nausch B, Koeberle A, Werz O, Ammendola A, Künstle G. 2016. 262 Canephron® N reduces pain in experimental cystitis and prostatitis putatively by inhibition of PGE2 production. European Urology Supplements. 15:e262. Google Scholar. https://doi.org/10.1016/S1569-9056(16)60264-6

15. Künstle G, Brenneis C, Pergola C, Werz O, Haunschild J. 2013. Anti-inflammatory effects of Canephron® N and effectiveness in a model of interstitial cystitis. Urologe 52 (suppl 1):e97. Google Scholar.

16. Brenneis C, Künstle G, Haunschild J. Spasmolytic Activity of Canephron® N on the Contractility of Rate and Human Isolated Urinary Bladder: 13th International Congress of the Society for Ethnopharmacology. 2nd to 6th September 2012. Graz, Austria. Google Scholar.

17. NICE Resource impact report: Urinary tract infection in under 16s: diagnosis and management (CG54): National Institute for Health and Care Excellence. 2018.

18. Martin Bland An introduction to medical statistics: Oxford University Press, 4th edition. 2015: 464. ISBN 978-0-19-958992-0