eaberry in the treatment of acute uncoplcated cystitis (BRUMI): protocol of a multicentre, randomised double-blind clinical trial

BACKGROUND

Bearberry (Arctostaphylos uva-ursi) leaf is available as a treatment of uncomplicated cystitis in several European countries. The antimicrobial activity of its extracts and some of its individual constituents has been observed in vitro; however, the efficacy of bearberry compared with standard antimicrobial therapy has not been assessed yet.

OBJECTIVE

The objective of the study is to assess the safety and non-inferiority of bearberry as an alternative therapy in the treatment of acute uncomplicated cystitis in comparison with standard antibiotic therapy (fosfomycin).

METHODS AND ANALYSIS

This is a randomised controlled double-blinded multicentre trial. Eligible patients will be premenopausal women with a sum score of ≥6 for the typical acute uncomplicated cystitis symptoms (frequency, urgency, painful urination, incomplete emptying, suprapubic pain and visible haematuria) reported on the Acute Cystitis Symptom Score (ACSS) typical domain and pyuria. Patients will be randomly assigned to receive 3 g single dose of fosfomycin powder and two placebo tablets three times a day for 7 days or B a single dose of placebo powder and two tablets containing a dry extract of Uvae ursi folium. At least 504 patients (allocated as 1:1) will need to be enrolled to access non-inferiority with a non-inferiority limit of 14% for the primary endpoint.Improvement of symptoms of uncomplicated cystitis (based on the ACSS score) at day 7 is defined as the primary endpoint, whereas several secondary endpoints such as the number and ratio of patients with bacteriuria at day 7, frequency and severity of side effects; recurrence of urinary tract infection, concurrent use of other over the counter (OTC) medications and food supplements will be determined to elucidate more detailed differences between the groups. The number of recurrences and medications taken for treatment will be monitored for a follow-up period of 90 days (80-100 days).

ETHICS AND DISSEMINATION

This study has been approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (IV/4225-1/2021/EKU). The results will be disseminated by publication of peer-reviewed manuscripts.

TRIAL REGISTRATION NUMBER

NCT05055544.

Quality Standards for Herbal Drugs and Herbal Drug Preparations - Appropriate or Improvements Necessary?

Standards for quality control as defined in the European Pharmacopoeia contribute significantly to a consistent and high quality of herbal drugs, herbal drug preparations, and herbal medicinal products. The minimum content of single plant constituents is considered of high relevance. Therefore, nearly all monographs on herbal drugs or herbal drug preparations contain an obligatory assay.However, a critical evaluation of the data published for such assayed constituents reveals that in most cases these constituents have to be considered as purely analytical markers without correlation to quality or efficacy. Examples where the assay does not meet its objective support the need to adapt current quality standards. Moreover, the trend to increase the content of certain constituents may lead to significant modifications to traditional manufacturing processes.In order to initiate a scientific discussion, the role of the assay in the context of quality requirements, quality documentation in the manufacturing process, safety, and efficacy is discussed and possible alternatives to the single marker assay are examined.

[The HMPC monograph on Hypericum: Background, development, contents]

The adoption of the EU community monograph on Hypericum constitutes a milestone in the process of harmonisation of herbal medicinal products within the European Community. The assessment of the published clinical data revealed that for two types of extracts the evidence of the efficacy in mild to moderate depressive episodes compared to placebo or standard medication was found to be acceptable. Additionally, a sufficient efficacy in relapse prophylaxis could be demonstrated for these two herbal preparations. For some other dry extracts, the efficacy in the short-term treatment of symptoms in mild depressive disorders was found to be substantiated. Short-term treatment with preparations containing low amounts of hyperforin did not increase cytochrome P450 enzyme activity. Therefore the oral administration of traditional herbal preparations is restricted to two weeks. In the case that an applicant demonstrates that the daily intake of hyperforin is below 1 mg the warnings on interactions may be omitted in traditional herbal medicinal products. Additionally the cutaneous administration of traditional liquid herbal preparations for the traditional use in symptomatic treatment of minor inflammations of the skin and as an aid in healing minor wounds was included in the monograph.

Equisetum Crude Drugs: Epidermal Characters for Identification

Epidermal characters of nine of the Central European Equisetum species were documented using both scanning electron and light microscopy. The arrangement of silica pilulae on the subsidiary cells of stomata as well as the type and the arrangement of papillae on the ridges of main stems and branches allow an unambiguous identification of the species even in the powdered state. A key for the identification is presented, and recommendations for an improved text for the monograph in the European Pharmacopeia are given.

Anatomy of the underground parts of four Echinacea-species and of Parthenium integrifolium

Improved descriptions and detailed drawings of the most important anatomical characters of the roots of Echinacea purpurea (L.) MOENCH, E. angustifolia DC., E. pallida (NuTT.) NUTT., and of Parfhenium integrifolium L. are presented. The anatomy of the rhizome of E. purpurea, which was detected in commercial samples, and of the root of E. atrorubens NUTT., another known adulteration for pharmaceutically used Echinacea-species, is documented for the first time. The possibilities and limitations of the identification by means of microscopy are discussed. The anatomical differences between the roots of E. angustifolia, E. pallida and E. atrorubens are notsufficient for differentiation, however, root and rhizome of E. purpurea and the root of Parthenium integrifolium appear well characterized. Because of the highly similar anatomy the microscopic proof of identity and purity of crude drugs of Echinacea must be done with uncomminuted material and the examination of cross sections.