Antibiotic-sparing and adjunctive phytotherapy in acute cystitis: the anti-adhesion approach
DOI: 10.22591/magyurol.2026.2.molnarpj.96
Authors:
Molnár Péter József dr.
Semmelweis Egyetem, Urológiai Klinika, Budapest
Summary
The acute uncomplicated lower urinary tract infection is one of the most common entities in urological, primary care and gynecological practice. Although antibiotics remain essential in the treatment of bacterial urinary tract infections, increasing antimicrobial resistance, microbiome disruption and frequent recurrence have stimulated interest in antibiotic-sparing strategies. In the 2026 EAU Guidelines on Urological Infections, non-antibiotic options are specifically addressed in the management of cystitis and may be considered as alternatives in selected non-geriatric patients through shared decision-making. A number of medicinal plants can be used in the treatment of acute, uncomplicated cystitis, including in combination with antibiotics. Canadian and tall goldenrod, as well as nettle, primarily support urinary tract flushing and exert an aquaretic effect, while Orthosiphon stamineus and Ononis spinosa combine aquaretic activity with anti-adhesive and inflammation-modulating mechanisms.
The aim of this review is to present the clinical relevance of urinary tract infections, guideline-based treatment steps, and the evidence supporting phytotherapy.