Антибіотикорезистентність і вакцинація при інфекції сечового тракту Antibiotic resistance and vaccination in patients with urinary tract infection

Limited in experience of using uroantiseptics, even those manufactured in European countries, such as Furamag and Macmiror, excessive use of antibiotics, which causes antibiotic resistance in the EU countries and form resistance to antibiotics. The problem of treatment resistant, recurrent infections of the urinary tract and asymptomatic bacteriuria can be solved with vaccinotherapy. Urivac may recommend as an independent option or in combination with prophylactic treatment with uroanticeptic and/or phytomedicine.

Annually, the European Association of Urology (EAU) presents clinical guidelines on urological infections [1], which are taken as a basis for the treatment of asymptomatic bacteriuria, cystitis and pyelonephritis [2].While having unquestionable advantages in the diagnosis and the best medical practice, yet the European Guidelines for Treatment of Urinary Tract Infections are: -Limited in experience of using uroantiseptics, even those manufactured in European countries, such as Furamag and Macmiror, and may therefore result in еxcessive use of antibiotics, which causes antibiotic resistance in the EU countries; -They do not contain treatment evidence in Eastern European population; -They are based on personal traditions of the physicians and mentality of the European population [3].
Currently in Ukraine, there is no evidence of antibiotic resistance in urinary tract infections.Traditionally, we use urinary antiseptics, but not antibiotics to manage cystitis.Thus, less cases of antibiotic-resistant asymptomatic bacteriuria can be expected as a negative outcome of UTIs treatment.
The study of biofilms and the growing antibiotic resistance [8-10] have changed the European view on asymptomatic bacteriuria, which is now considered generally a benign, and sometimes a protective condition [11].Evolutionary, microorganisms and humans have developed the ability to co-exist; the conditionally pathogenic microflora has developed the persistence features [12].Therefore, the EAU 2017 proposes not to treat asymptomatic bacteriuria in non-pregnant women, people with diabetes, nursing home patients, those who have lumbar spinal cord injury and bladder catheters [13][14][15][16][17].
In general, it is possible to agree with the inappropriateness of repeated use of antibiotics (urinary antiseptics) in case of bacteriuria unresolved after previous treatment [18].However, sterile urine still seems a more attractive outcome of UTIs treatment.
Which tactics can be considered in treatment of bacteriuria unresolved after treatment?The following options are available: -Case follow-up; -The use of phytopreparations of uroantiseptic action; -Vaccination with autovaccines or industrially manufactured medicines [19].
With certain assumptions, phytomedicins may be attributed to naturally occurring urinary antiseptics.Such therapy is very effective and, in our opinion, more attractive than case follow-up.
Vaccination is an alternative approach, which, based on the formation of immune response, allows the body to independently determine the feasibility of bacteriuria as a protective reaction or non-sterile immunity.
In the early 20 th century, A. Wright (1903-1904) substantiated that the principles of active immunization were important not only as preventive care, but also as treatment, and began to use the term "vaccine therapy".
Vaccine therapy is based on multiple systemic exposure of a specific antigenic agent on the body that is accompanied by the production of specific antibodies and an increase of total body resistance.Vaccination is used mainly in chronic recurrent infections.
The peculiarities of the formation of an immune response limit the effective use of vaccines in children aged 5 to 6 years old, and may have certain features in the elderly.Autovaccine produced from its own pathogen is a golden standard, but in comfort terms is inferior to industrially prepared medicine.Among the latter, the most famous in UTIs are the following two: Uro-Vaxom and Urivac.
Comparison of Uro-Vaxom and Urivac tends toward Urivac [20].Its advantages are as follows: more convenient mode of administration (30 capsules for 3 months), antigens of 5 pathogens against one and cost-effectiveness.
Another important reason for using Urivac polyvaccine is that the E.coli can mask the causative microbial agent by suppressing its growth during urinalysis.Therefore, the polyvaccine production tactics is more reasonable (let's remember flu vaccination or with Broncho-Vaxom).
What are the target groups for vaccination?-Recurrent urinary tract infections (more than twice in six months or three times a year) in spite of repeated courses of antibiotic or uroantiseptic therapy.
-Failure of at least two courses of antimicrobial therapy and unresolved bacteriuria.
-Preventive treatment of recurrent episodes of urinary tract infections in risk groups (vulvitis or vulvovaginitis in girls and women, people with diabetes, nursing home patients, those with spinal cord injury and bladder catheters, women planning pregnancy, and previous urinary tract infections).
-Urethral syndromes and cystitis triggered by sexual intercourse.
It is feasible to vaccinate children over 4 to 6 years of age with asymptomatic and symptomatic bacteriuria.
People in Eastern Europe are different from those living in the West Europe, both in terms of genotype and mentality.It is expedient to use the benefits of developed countries and implement the accumulated experience.Among its achievements is the use of urinary antiseptics as initial therapy (Furamag, Macmiror) instead of antibiotics for the treatment of urethral syndrome and cystitis without concomitant sexually transmitted infections, close follow-up of pregnant women with bacteriuria and their treatment as a risk group; using not more than 3 courses of antibiotic therapy in urinary system infections, which are not accompanied by temperature rise; and wider use of vaccination, in particular, Urivac polyvaccine in order to achieve sterile urine or prevent recurrent urinary tract infections.Vol. 7, No.

Antibiotic resistance and vaccination in patients with urinary tract infection
Abstract.Limited in experience of using uroantiseptics, even those manufactured in European countries, such as Furamag and Macmiror, excessive use of antibiotics, which causes antibiotic resistance in the EU countries and form resistance to antibiotics.The problem of treatment resistant, recurrent infections of the urinary tract and asymptoma-tic bacteriuria can be solved with vaccinotherapy.Urivac may recommend as an independent option or in combination with prophylactic treatment with uroanticeptic and/or phytomedicine.Keywords: urinary tract infection; uroantisceptics; antibiotic resistance; vaccine therapy; Urivac 1, 2018