title: Efficacy of an orally administered combination of hyaluronic acid, chondroitin sulfate, curcumin and quercetin for the prevention of recurrent urinary tract infections in postmenopausal women.
abstract: OBJECTIVE
  To assess whether the orally administered combination of hyaluronic acid (HA), chondroitin sulfate (CS), curcumin and quercetin could be effective in preventing recurrent cystitis in postmenopausal women and whether its efficacy was conditioned by the concurrent use of local estrogen therapy.
  
  
  METHODS
  This was a prospective evaluation of 145 postmenopausal women consecutively recruited from the database of three different investigators. All women should have mild-to-moderate urogenital atrophy and a history of recurrent urinary tract infections (≥2 episodes within 6 months or ≥3 episodes within 12 months documented by positive urine cultures) during the last year. Patients were assigned to three different therapeutic regimens: the first group was treated only with vaginal estrogens, the second group only with HA, CS, curcumin and quercetin per os, and the third group was treated with HA, CS, curcumin and quercetin associated with local estrogens. We evaluated the number of patients with <2 infective episodes in the 6-month follow-up and <3 episodes in the 12-month follow-up (main aim definition) and the reduction of related symptoms through a Visual Analog Scale (VAS) and the Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale. Student's t-test and chi-squared test were used for data analysis as appropriate.
  
  
  RESULTS
  At 6-month follow up, the main aim rate was 8%, 11.1% and 25% in the three groups, respectively (p<0.05 compared to baseline only in group 3). Although the reduction in the number of recurrent episodes became significant in all groups at 1 year follow-up, the main aim rate was almost double in women receiving both local estrogens and oral therapy (group 3) compared to those receiving single treatments. The improvement of related symptoms was significant in all groups at 12-month follow-up.
  
  
  CONCLUSIONS
  In postmenopausal women, the combination of HA, CS, curcumin and quercetin per os was effective in preventing recurrent urinary tract infections, especially if administered with vaginal estrogen therapy.
authors.affiliation: Department of Women, Children and of General and Specialized Surgery - Second University of Studies of Naples Largo Madonna delle Grazie 1, 80138 Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Torella
authors.affiliation: Department of Women, Children and of General and Specialized Surgery - Second University of Studies of Naples Largo Madonna delle Grazie 1, 80138 Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Del Deo
authors.affiliation: Department of Women, Children and of General and Specialized Surgery - Second University of Studies of Naples Largo Madonna delle Grazie 1, 80138 Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Grimaldi
authors.affiliation: Department of Women, Children and of General and Specialized Surgery - Second University of Studies of Naples Largo Madonna delle Grazie 1, 80138 Naples, Italy.
authors.forename: S A
authors.initials: SA
authors.lastname: Iervolino
authors.affiliation: Department of Women, Children and of General and Specialized Surgery - Second University of Studies of Naples Largo Madonna delle Grazie 1, 80138 Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pezzella
authors.affiliation: Department of Women, Children and of General and Specialized Surgery - Second University of Studies of Naples Largo Madonna delle Grazie 1, 80138 Naples, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Tammaro
authors.affiliation: Maternal and Child Department - Cremona Hospital - A. O. Istituti Ospitalieri di Cremona Viale Concordia 1, 26100 Cremona, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Gallo
authors.affiliation: Department of Obstetrics and Gynaecology - Buon Consiglio Fatebenefratelli Hospital Via Alessandro Manzoni 220, 80123 Naples, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Rappa
authors.affiliation: Department of Women, Children and of General and Specialized Surgery - Second University of Studies of Naples Largo Madonna delle Grazie 1, 80138 Naples, Italy.
authors.forename: P
authors.initials: P
authors.lastname: De Franciscis
authors.affiliation: Department of Women, Children and of General and Specialized Surgery - Second University of Studies of Naples Largo Madonna delle Grazie 1, 80138 Naples, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Colacurci
mesh_terms: D000375:Aging; D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects / Q000627:therapeutic use; D000975:Antioxidants / Q000009:adverse effects / Q000627:therapeutic use; D059268:Atrophic Vaginitis / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D002809:Chondroitin Sulfates / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000009:adverse effects; D003474:Curcumin / Q000009:adverse effects / Q000627:therapeutic use*; D019587:Dietary Supplements / Q000009:adverse effects; D060467:Disease Resistance / Q000187:drug effects; D004964:Estriol / Q000009:adverse effects / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D004967:Estrogens / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D017698:Postmenopause; D011794:Quercetin / Q000009:adverse effects / Q000627:therapeutic use*; D055502:Secondary Prevention; D012720:Severity of Illness Index; D014552:Urinary Tract Infections / Q000150:complications / Q000382:microbiology / Q000517:prevention & control* / Q000652:urine; D014622:Vaginal Creams, Foams, and Jellies / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000892:Anti-Infective Agents, Urinary; D000975:Antioxidants; D004967:Estrogens; D014622:Vaginal Creams, Foams, and Jellies; D006820:Hyaluronic Acid; D002809:Chondroitin Sulfates; D011794:Quercetin; D004964:Estriol; D003474:Curcumin
keywords: Curcumin; Estrogen; Glycosaminoglycans; Quercetin; Urinary tract infections