[Prevention of reinfection by L-methionine in patients with recurrent urinary tract infection].
OBJECTIVE
A great variety of different antimicrobial chemotherapeutics is available for the treatment of urinary tract infections. Influencing the course of chronic diseases is a problem because recurrent diseases may result in disturbances of renal and bladder functions as well as in irreversible damages of the renal parenchyma. The present investigations are expected to clarify whether an effective prevention of reinfection in patients with chronically recurrent urinary tract infection is possible by a regular administration of L-methionine (Acimethin).


METHODS
33 female patients were included in the examinations. Following acute disease, 23 females (aged: 47.4 +/- 13.3 years) were treated with 3 x 1 tablet of Acimethin (L-methionine) daily over a period of 26 months. Ten female patients (aged: 47.4 +/- 12.2 years) taking 1 tablet of Nevigramon (nalidixic acid) three times daily over 21.6 months served as a control group. Before starting treatment and in the middle of the therapy period control examinations were performed and following the last drug administration so as to assess the therapeutic result.


RESULTS
No acute infection occurred during L-methionine treatment. All parameters of inflammation (leucocyte count, C-reactive protein, blood sedimentation rate, alpha 2-globulin concentration) were in the normal range; no impairment of renal function was observed. Although L-methionine, i.e. nalidixic acid, did not yield any significant changes in the range of bacteria, the adherence of uropathogenic microorganisms to the cells of the urinary tract was reduced. Before L-methionine treatment, the average load of the uroepithelial cells was 95.9 +/- 73.6 bacteria per cell. When the observation period was completed, 51.2 +/- 56.4 bacteria per cell were registered (p < 0.03). During nalidixic acid treatment, the rate of adherence was reduced from 74.0 +/- 88.4 to 34.4 +/- 37.8 bacteria per cell (p < 0.25). During L-methionine treatment, no Escherichia coli strains that are able to produce hemolysin or to form aerobactine were found. Among agents adhering to uroepithelial cells, however, an increase in their ability to produce mannose-resistant hemagglutination was conspicuous.


CONCLUSIONS
L-methionine is suitable to prevent reinfection with chronic urinary tract infection. The therapeutic result is essentially due to its influence on bacterial cytoadherence. In contrast to the established recommendations concerning the prevention of reinfection by the use of antibiotics and sulphonamides selecting resistant strains during long-term treatment, nothing is known about the development of resistance to L-methionine.
Fünfstück
R
R
Klinik für Innere Medizin IV, Friedrich-Schiller-Universität Jena.
Straube
E
E
Schildbach
O
O
Tietz
U
U
D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects; D001437:Bacteriuria / Q000209:etiology / Q000517:prevention & control; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008715:Methionine / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009268:Nalidixic Acid / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*
D000890:Anti-Infective Agents; D009268:Nalidixic Acid; D008715:Methionine