Antibiotic Use Must Be Reduced

Letters to the Editor The Diagnosis, Treatment, and Prevention of Recurrent Urinary Tract Infection by PD Dr. med. Guido Schmiemann; PD Dr. med. habil. Jennifer Kranz, FEBU, MHBA; Dr. med. Falitsa Mandraka, MME; Prof. Dr. med. Sören Schubert; Prof. Dr. med. Florian Wagenlehner; and Prof. Dr. med. Ildikó Gágyor in issue 11/2024

Schmiemann et al tackled an enormously relevant medical as well as health political subject. In this setting, the perspective on scientific aspects alone is not enough. Mass prescribing of antibiotics contributes to the development of resistance individually as well as generally. The transmission routes—including the environmental stress caused thereby, such as affecting the food chain—are well known. At the individual level, repeated antibiotic use can cause impairment of a patient’s microbiome. This affects the microbiome of the bladder, vagina, and bowel and is associated with the occurrence of subsequent impairments to bowel motility, recurrent infections, and dyspareunia (1, 2). Alternative treatment methods are required. Microbiome analysis by means of next generation sequencing (NGS) enables the analysis of the totality of microorganisms in a complex microbiome. As a result of the development of a nationwide logistics system in the setting of the corona pandemic, a multitude of laboratory providers currently exists. On the basis of recent research, imbalances in the microbiome—so called dysbiosis—can be assigned to relevant disorders and thus lead patients to individualized, targeted therapy (3). Without the slightest doubt, antibiotics cause damage to the individual microbiome, which in turn can become the cause of recurrent urinary tract infections. The focus should be on a healthy microbiome—a so called eubiome—rather than of mass use of antibiotics—especially in uncomplicated urinary tract infections.

DOI: 10.3238/arztebl.m2024.0163

Prof. Dr. med. Thomas Otto

PD Dr. med. Dimitri Barski

Urologische Klinik

Rheinland Klinikum Neuss

Conflict of interest statement

The authors declare that no conflict of interest exists.

References

1. Schiereck T, Yeldan S, Kranz J, et al.: [Urinary bladder microbiome analysis and probiotic treatment options for women with recurrent urinary tract infections]. Urologe 2022; 61: 41–51.

2. Biehl LM, Farowski F, Hilpert C, et al.: Longitudinal variability in the urinary microbiota of healthy premenopausal women and the relation to neighboring microbial communities: a pilot study. PLoS One 2022; 17: e0262095.

3. SFB 1371 – Microbiome Signatures Sonderforschungsbereiche (SFB) Technische Universität München, www.sfb.tum.de/1371/microbiome-signatures/ (last accessed on 13 June 2024).

4. Schmiemann G, Kranz J, Mandraka F, Schubert S, Wagenlehner F, Gágyor I: The diagnosis, treatment, and prevention of recurrent urinary tract infection. Dtsch Arztebl Int 2024; 121: 373–82.