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Introduction: Urinary tract infections (UTI) in patients with neurogenic lower urinary tract dysfunction (NLUTD) are defined as complicated UTI requiring antibiotic treatment. As the emergence of multiresistant strains is a serious problem, we assessed the feasibility of nonantibiotic treatment of UTI in patients with NLUTD. Materials and Methods: In a prospective study evaluating the usefulness of UTI prophylaxis, participants could opt for either antibiotic or nonantibiotic treatment of breakthrough UTI. If either symptoms persisted for 48 h or a febrile UTI occurred, antibiotic treatment based on microbiological testing was mandatory. Treatment efficacy, complications, and emergency hospital visits were assessed. Results: Within the observation period (1 year), the 25 participants developed 206 UTI. Seven febrile UTI required immediate antibiotic treatment. Of the remaining 199 UTI, patients chose antibiotic treatment in 104 events, whereas in 95 events, patients chose either nonantibiotic interventions (n = 80) or no treatment at all (n = 15). Success rates were 78.8% for antibiotic treatment, 67.5% with nonantibiotic treatments, and 26% without therapy. Of the 7 patients with initially febrile UTI, 2 required hospitalization due to septicemia. Conclusions: Nonantibiotic treatment seems to be a feasible alternative to antibiotic therapy in patients with complicated UTI as well, provided there is no fever. [ABSTRACT FROM AUTHOR]

Background Recurrent urinary tract infections (UTIs) are one of the most common morbidities in persons with neurogenic lower urinary tract dysfunction (NLUTD). Repetitive antibiotic treatment increases the risk of selecting multi-resistant bacteria. Homeopathic treatment has been reported to be effective in these patients. The mechanism of action, however, has not been clarified. Recently, a direct bactericidal effect of homeopathic remedies was shown. Such an effect is not in accordance with the general principles of homeopathy. To test this paradigm, we assessed the in vitro effects of homeopathic drugs on Escherichia coli derived from patients with NLUTD. Methods E. coli bacteria were harvested from28 consecutive urine cultures. Standard antibiotic resistance testing and simultaneous resistance testing to homeopathic drugs (Apis mellifica, Cantharis, Causticum hahnemanni, Staphysagria, Nux vomica, Berberis vulgaris, and Lycopodium clavatum) in high (C30) potency were performed. Results No significant inhibitory effect of any of the tested homeopathic drugs on any E. coli population could be found, irrespective of their sensitivity to antibiotic treatment. Conclusion Based on our results, effects of homeopathic treatment of UTI are not based on direct bactericidal or bacteriostatic effects. These findings are in concordance with the hypothesis that homeopathy is based on host effects: for example, activation of the immune system, rather than effects on pathogens. [ABSTRACT FROM AUTHOR]