Since their introduction in the 1980s, fluoroquinolones were used extensively due to their broad antimicrobial spectrum, availability in both oral and parenteral formulations, and low toxicity profile. Fluoroquinolones became the firstline treatment for UTIs in many areas where resistance to trimethoprim-sulfamethoxazole was prevalent (Warren et al., 1999
). Since then, large surveillance studies of clinical isolates in North America and Europe detected fluoroquinolone resistance in a wide range of isolates (Jones et al., 2002
; Sahm et al., 2001
A variety of mechanisms might lead to fluoroquinolone resistance; these included target modification of the DNA gyrase and topoisomerases and decreased drug concentrations within bacteria mediated by efflux pumps and a loss of porins. Organisms were believed to require several mutational events to develop resistance to fluoroquinolones (Hooper et al., 2001
). Although it was possible to select fluoroquinolone-resistant isolates by performing serial passages in the presence of subinhibitory concentrations of various fluoroquinolones (Gilbert et al., 2001
), it was considered relatively difficult (Smith, 1986
). In contrast to these laboratory observations, it was believed that resistance to fluoroquinolones emerged often in clinical isolates.
Some Chinese herbs in the study were proved to have antibacterial activity (Tong et al., 2006
). These properties had prompted their compound prescription use in the management of UTI. With that in mind, we analyzed the effects of these Chinese herbs on the uncomplicated UTIs caused by fluoroquinolone-resistant strains in women.
In this study, the subjects were relatively young, with a median age of only 32 years. Escherichia coli was the principal infecting organism, and Pseudomonas aeruginosa was the second most frequent.
Assessment of treatment outcome in antibiotic trials of UTIs had long been problematic. Inconsistent definitions of clinical cure, differing criteria for bacteriologic cure, and the subjective all-encompassing criterion of investigator assessment prevented a rigorous conclusion of published studies. We used two criteria in time: clinical and bacteriologic response. The clinical response, judged by patients' signs and symptoms, was quiet good, with cure or improvement for more than 70% of all subjects in all analyses at 1 week after treatment ().
The therapeutic results of Chinese herbs were expected to be poor in the patients wih infections previously. Yet these Chinese herbs eradicated most of the primary pathogens from the urine, and a cure rate of 71.4% at the 1-week-follow-up was accomplished. The data from this study showed that Chinese herbal concoction was effective in its ability to eradicate chronic baeteriuria, the only valid criterion for successful treatment.
The tolerance and safety of Chinese herbal concoction were considered excellent in this preliminary trial with only mild adverse clinical symptoms occurred which disappeared after discontinuation of the medication. Moreover, no subjects were lost to follow-up.
Even if a treatment was efficacious, it might not be possible to determine the mechanism of action and the active substances immediately, particularly in herbal treatments that contained many compounds. One had to expect the possibility that some chemical interactions took place among natural constituents existing in the component herbs of the formula during decoction. Decoction might change the extraction rates of the active ingredients and/or produced new artificial substances, which might then exhibit new pharmacological activities. However, a mixture of several crude extracts could have greater beneficial effects compared with a single plant extract while properly used. First, crude herbs given in combination could act synergistically. Second, they could have unknown interactions but could interact to diminish possible adverse side effects of one or more of the components. Finally, their combination could prevent the gradual decline in effectiveness observed when single herbs were given over long periods of time (Matsuo et al., 1994
The design of our study had some shortcomings. A randomized-controlled double-blind trial would have been ideal but was not deemed feasible in this study given the oral route of administration for Chinese herbal concoction. Obviously this initial limited therapeutic trial must be extended to a larger group of patients and included long-term follow-up evaluations before a definite conclusion could be drawn. In spite of these limitations, it appeared that Chinese herbal therapy might be an acceptable alternative for the treatment of uncomplicated UTIs caused by fluoroquinolone-resistant uropathogens.