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"We have read for you": recurrent cystitis, N-acetylcysteine, D-Mannose and Morinda citrifolia

Last week I read for you “Efficacy of N-acetylcysteine, D-mannose and Morinda citrifolia to Treat Recurrent Cystitis in Breast Cancer Survivals” study by Doctor Debora Marchiori and Doctor Pier Paolo Zanello.

The study showed that traditional antibiotic therapy, when administered in combination with an N-Acetylcysteine-based supplement, D-Mannose and Morinda Citrifolia, instead of generating resistance, reduces urine culture positivity of 87% (first check detected result, carried out two months after the end of the intake cycle).

This study indicates the possibility of a new approach to eradicate infections and to prevent recurrent urinary infections. The suggested approach by researchers also makes it possible to reduce the need for recurrent antibiotic therapies, often responsible for vaginal and intestinal flora imbalances (with consequent recurrence phenomena) and for super-resistant bacterial strains creation.

The particularly delicate patients condition is a useful indicator of how it is possible to implement effective intervention strategies aimed at resolving recurrent urinary tract infections even in subjects with debilitated motion such as cancer and immunodepressed patients.

The study, specifically to better highlight the safety and efficacy of the intake of the ingredients listed above, involved patients with a history of breast cancer who managed to win their battle.

Every day around the world many women fight against a terrible enemy: breast cancer. Today the life expectancy of patients with breast cancer is very high, but it is often influenced by long-term cancer treatments. Breast tumors are often sensitive to hormones and among the currently used therapeutic options there is tamoxifen, aromatase inhibitors and LHRH. The decrease in the level of circulating estrogen caused by this therapy, in addition to lead to a condition of menopause, is responsible for atrophic vaginitis and urinary disorders. These latter are characterized by symptoms ranging from moderate to severe.

Estrogen deficiency induces urogenital syndrome with symptoms such as vaginal dryness, burning and irritation, sexual ones as lack of lubrication and dyspareunia and urinary symptoms such as urgency, frequency, incontinence and recurrent urinary tract infections.

The genitourinary syndrome, which is accompanied by bladder mucosa atrophy, is characterized by recurrent bacterial cystitis and post-coital cystitis mostly sustained by gram-negative bacteria.

The uropathogenic bacteria responsible for cystitis in these patients are usually Escherichia coli, Klebsiella, Shigella, Pseudomonas and are able to generate biofilms.

Biofilm is a mucopolysaccharidic matrix created by bacteria and represents a strategic and effective defense weapon against both antibiotics and immune defenses. Inside the biofilm, frequently of polymicrobial nature (which hosts both bacteria and fungi), microorganisms are protected and proliferate undisturbed.

Recently this theory has allowed us to change the therapeutic approach.

In order to minimize the chronicity of an infection and improve the effectiveness of antibiotics, the current prophylaxis is based on D-Mannose, N-acetylcysteine (NAC) and extract of Morinda citrifolia which together have a powerful antibacterial, anti-inflammatory, analgesic and immunomodulatory action.

D-Mannose has a high affinity with E. coli surface adhesins (the appendages that bacteria use to adhere to the mucosa) and its action, saturating the lectins, prevents the adhesion of bacteria to the urothelium. NAC has the ability to destroy the pathogenic biofilm and the extract of Morinda citrifolia is a powerful anti-inflammatory, immunostimulant and antimicrobial. Literature has shown an increase in the efficacy of Fosfomycin, Nitrofurantoin or Quinolones when associated with NAC in destroying biofilm and reducing the number of vital bacterial forms, respectively, against Staphylococcus aureus, Escherichia coli and Pseudomonaceae.

These results support the therapeutic perspective of antibiotic/NAC association, opening new and important therapeutic solutions in chronic infectious diseases of the respiratory and urinary tract, both supported by biofilm formation.

The clinical study was an observational retrospective one and was conducted on 60 breast cancer patients with recurrent cystitis, both in physiological menopause and in childbearing age.

The 60 patients observed were divided into two groups. Group 1 included 40 patients treated with:

A) variable antibiotic therapy, depending on microbial sensitivity and doses and for the duration prescribed by the doctor B) a food supplement with:

-D-mannose (500 mg) -N-acetylcysteine (200 mg) -Morinda citrifolia (dry extract 300 mg)

for single dose, with the following dosage:

for 60 days 1 vial every 12 hours after having emptied the bladder, followed by 1 vial every 24 hours for 4 months.

Group 2 included 20 patients treated only with antibiotics.

All patients at the first medical examination had a history of recurrent cystitis and had positive urinary cultures with bacterial prevalence of Escherichia coli and Klebsiella.

Culture tests, carried out two months after the end of the intake cycle, found that group 1 showed an important reduction in patients with positive urinary cultures: from 40 to 5, that is to say -87%. Group 2, on the other hand, showed a reduction of only 10%: from 20 to 18 patients with positive urine culture.

It is very important to emphasize that the efficacy of this association is positive not only to reduce urogenital discomfort in women with breast cancer, but also in all those conditions associated with the reduction of circulating estrogens. The decrease of circulating estrogens leads to changes at vaginal, vulvar, bladder and urethral levels and this seriously damages women and their quality of life (daily and intimate sphere).

Therefore more exposed patients to urogenital infections such as women suffering from endometriosis or being treated with continuous hormone therapy, it is important to have a therapeutic approach aimed at preserving the balance of the vaginal and intestinal bacterial flora, which lasts over time and does not cause the establishment of a biofilm-supported chronicity.

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