mandelamine(sp)

[kakkieko]

hi, i saw my urologist today for continuing uti symptoms after being on 3 different anti-biotics. he wants to try me on a drug called mandelamine. has anyone had any experience with this? he says it is an old drug rarely used anymore. the good thing about it he says is that i won't become resistant. i am becoming resistant to all my other drugs. and we do not treat until i become very symptomatic.

i am curious as to whether or not this also goes with my tethered spinalcord?

[marmalady]

Hi, Kathy Ann,

There's a medication website that I've found useful for looking things up - Rxmed.com - you might try that.

[Wise Young]

kathy ann,

Mandelamine is a very good drug for preventing bacterial infections of the bladder. It is not a true antibiotic. Most antibiotics interferes with some metabolic process in bacteria and bacteria have evolved a variety of genes that confers resistance to antibiotics. In fact, whenever you use an antibiotic for a long time, the remaining bacteria that survive are resistant to the antibiotic. Worse, they can pass the resistance to other bacteria that get into the urine. Eventually, this results in bacteria that are resistant to multiple antibiotics.

Mandelamine is called an "anti-infective". It is marketted under many brand names including Hiprex and Urex. It is a chemical (methanamine mandalate) that is largely secreted into the urine where it breaks down to formaldehyde and ammonia. Both of these substances are toxic to bacteria in urine. Note that mandelamine will break down into these two component agents only if and when the urine is acidic (pH is less than 7.4). For this reason, ascorbic acid is frequently given alongside mandelamine, to acidify the urine. The drug is ineffective if the urine is not sufficiently acid. Mildly acidic urine is not toxic to the bladder wall.

Formaldehyde is toxic because it fixes proteins and interferes with the general function of the bacteria. Bacteria cannot readily develop resistance to this drug. Also, because the chemical does not break down into these formaldehyde and ammonia until it is in the urine, it should not have much side effects. On the other hand, one can develop an allergy to mandelamine.

Please note that there are other agents that are anti-infective and can be taken alongside mandelamine. One of these is tannic acid (the stuff the makes wine taste bitter, coming from the oak barrels in which the wine is stored). Bacteria do not grow well in the presence of tannic acid. Good source of tannic acid is cranberry juice. Many people take cranberry concentrate alongside mandelamine to make it more effective.


Wise.

P.S. Here is an excellent article by a nurse on the subject of treating urinary tract infections: http://www.duj.com/Karlowicz.html

I remember hearing about this drug when I was a new injury in the 70's. Never tried it but was told it only worked if your urine was acidic. You may need to test your urine for ph.. Maybe you will need vitamin C supplements or something.

Great answer. You beat my post by a few minutes. One question, how much ascorbic acid is safe to take per day? I may be wrong but I thought I heard somewhere that too much can lead to problems with stones.

[Wise Young]

balley, sorry about beating your post... Regarding the amount of ascorbic acid, I would probably not take more than 2 grams a day. By the way, cranberry concentrate also contains vitamin C and therefore it can kill a couple of birds without stones 8-). Please note that there continues to be some controversy as to whether cranberry juice is helpful for preventing urinary tract infections. Here are some interesting articles:


• Biering-Sorensen F, Bagi P and Hoiby N (2001). Urinary tract infections in patients with spinal cord lesions: treatment and prevention. Drugs. 61 (9): 1275-87. Summary: Even though the mortality due to urinary tract complications has decreased dramatically during the last decades in individuals with spinal cord lesions (SCL), urinary tract infections (UTI) still cause significant morbidity in this population. Complicated UTI are caused by a much wider variety of organisms in individuals with SCL than in the general population and are often polymicrobial. Escherichia coli, Pseudomonas spp., Klebsiella spp., Proteus spp., Serratia spp., Providencia spp., enterococci, and staphylococci are the most frequently isolated bacteria in urine specimens taken from individuals with SCL. There is no doubt that the greatest risk for complicated UTI in these individuals is the use of an indwelling catheter. Intermittent catheterisation during the rehabilitation phase has been shown to lower the rate of UTI, and virtually eliminate many of the complications associated with indwelling catheters. Persons with SCL should only be treated for bacteriuria if they have symptoms. Generally, it is advisable to use antibacterial agents with little or no impact on the normal flora. Single agent therapy - in accordance with antimicrobial susceptibility test - is preferred. We advise extending treatment to at least 5 days, and in those with reinfection or relapsing UTI, at least 7 to 14 days, depending on the severity of the infection. The diagnosis of structural and/or functional risk factors is essential in order to plan an optimal treatment for UTI in individuals with SCL, which should include treatment of simultaneously occurring predisposing factors. The treatment of structural risk factors follows general urological principles, aiming for sufficient outlet from the bladder with minimal residual urine and low pressure voiding. For prevention of UTI, general cleanliness and local hygiene should be encouraged. If the patient has a reinfection or relapsing symptomatic UTI, it is important to check for inadequately treated infection and complications, which need special attention, in particular residual urine and urinary stones. No reliable evidence exists of the effectiveness of cranberry juice and other cranberry products. Prophylactic antibacterials should only be used in patients with recurrent UTI where no underlying cause can be found and managed, and in particular if the upper urinary tract is dilated. Antibacterials should not be used for the prevention of UTI in individuals with SCL and indwelling catheters. However, the use of prophylactic antibacterials for individuals with SCL using intermittent catheterisation or other methods of bladder emptying is controversial. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11511022> Clinic for Para- and Tetraplegia, Copenhagen University Hospital, Rigshospitalet, Denmark. finbs@rh.dk

• Jepson RG, Mihaljevic L and Craig J (2000). Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2: Summary: BACKGROUND: Cranberries (particularly in the form of cranberry juice) have been used widely for several decades for the prevention and treatment of urinary tract infections. The aim of this review is to assess the effectiveness of cranberries in preventing such infections. OBJECTIVES: To assess the effectiveness of cranberry juice and other cranberry products in preventing urinary tract infections in susceptible populations. SEARCH STRATEGY: Electronic databases and the Internet were searched using English and non English language terms; companies involved with the promotion and distribution of cranberry preparations were contacted; reference lists of review articles and relevant trials were searched. SELECTION CRITERIA: All randomised or quasi randomised controlled trials of cranberry juice/products for the prevention of urinary tract infections in susceptible populations. Trials of men, women or children were included. DATA COLLECTION AND ANALYSIS: Reviewers RJ and LM independently assessed and extracted information using specially designed data extraction forms. For each included trial, information was collected on methods of the trial, participants, interventions and outcomes. We were unable to perform statistical analysis due to the nature of the data available for review. MAIN RESULTS: Four trials met the inclusion criteria (three cross-over, one parallel group). Three compared the effectiveness of cranberry juice versus placebo juice or water and one compared the effectiveness of cranberry capsules versus placebo. Two further trials were excluded. The outcomes of interest were number of urinary tract infections in each group (symptomatic and asymptomatic), side effects and adherence to therapy. Data from three out of the four trials indicated that cranberries were effective for at least one of the outcomes of interest. The quality of the four included trials was poor, however, and thus the reliability of the results must be questionable. REVIEWER'S CONCLUSIONS: The small number of poor quality trials gives no reliable evidence of the effectiveness of cranberry juice and other cranberry products. The large number of dropouts/withdrawals from the trials indicates that cranberry juice may not be acceptable over long periods of time. Other cranberry products such as cranberry capsules may be more acceptable. On the basis of the available evidence, cranberry juice cannot be recommended for the prevention of urinary tract infections in susceptible populations. Further properly designed trials with relevant outcomes are needed. <http://www.ncbi.nlm.nih.gov/htbin-po...r&uid=10796774
http://www.update-software.com/abstracts/ab001321.htm> 15 Blackwood Crescent, Edinburgh, UK, EH9 1QZ. ruthj@ibm.net

• Kirchhoff M, Renneberg J, Damkjaer K, Pietersen I and Schroll M (2001). [Can ingestion of cranberry juice reduce the incidence of urinary tract infections in a department of geriatric medicine?]. Ugeskr Laeger. 163 (20): 2782-6. Summary: INTRODUCTION: The incidence of urinary tract infections was compared in two geriatric units, where patients were offered cranberry juice and the usual mixed berry juice, respectively. METHODS: In all cases where urinary tract infection was suspected, the doctors noted symptoms and signs used as indication for urinary culture. The urine collected from men was the usual mid-flow specimen, whereas the specimens from women were taken from a bedpan and by catheter. End points were the prevalence of symptoms leading to urine culture, specimens with significant growth of bacteria, and the use of antibiotics. RESULTS: Urine specimens were cultured in 140/338 cases. The reason for culture in 23% was general symptoms and in 62% urinary tract symptoms. A significant growth of bacteria was found in 54% and this information led to antibiotic treatment in 44%. In all cases (n = 55) where bedpan and catheter specimens were taken, the results were identical. CONCLUSION: Cranberry juice in a geriatric department, where the mean stay was 4 weeks, did not influence the incidence of urinary tract infections. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11374214> H:S Kommunehospitalet, geriatrisk afdeling, og.

• Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M and Uhari M (2001). Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. Bmj. 322 (7302): 1571. Summary: OBJECTIVE: To determine whether recurrences of urinary tract infection can be prevented with cranberry-lingonberry juice or with Lactobacillus GG drink. Design: Open, randomised controlled 12 month follow up trial. SETTING: Health centres for university students and staff of university hospital. PARTICIPANTS: 150 women with urinary tract infection caused by Escherichia coli randomly allocated into three groups. Interventions: 50 ml of cranberry-lingonberry juice concentrate daily for six months or 100 ml of lactobacillus drink five days a week for one year, or no intervention. Main outcome measure: First recurrence of symptomatic urinary tract infection, defined as bacterial growth >/=10(5 )colony forming units/ml in a clean voided midstream urine specimen. RESULTS: The cumulative rate of first recurrence of urinary tract infection during the 12 month follow up differed significantly between the groups (P=0.048). At six months, eight (16%) women in the cranberry group, 19 (39%) in the lactobacillus group, and 18 (36%) in the control group had had at least one recurrence. This is a 20% reduction in absolute risk in the cranberry group compared with the control group (95% confidence interval 3% to 36%, P=0.023, number needed to treat=5, 95% confidence interval 3 to 34). CONCLUSION: Regular drinking of cranberry juice but not lactobacillus seems to reduce the recurrence of urinary tract infection. <http://www.ncbi.nlm.nih.gov/htbin-po...r&uid=11431298
http://bmj.com/cgi/content/full/322/7302/1571> Department of Pediatrics, University of Oulu, Oulu, Fin-90220, Finland. terokontiokari@oulu.fi

• Reid G (1999). Potential preventive strategies and therapies in urinary tract infection. World J Urol. 17 (6): 359-63. Summary: There are perhaps five strategies either presently advocated or under investigation for prevention of recurrent urinary tract infection (UTI): antibiotics, including natural peptides; functional foods; vaccines; probiotics; and miscellaneous, including avoidance of spermicides and maintenance of good hygiene. It is not possible to state the proportion of patients using antibiotics versus foods such as cranberry or using alternative approaches such as avoidance of spermicides. The majority of women who are referred to specialists will be prescribed long-term, low-dose antibiotics. However, given the magnitude of the problem, it is safe to state that large numbers of women are at least experimenting with alternative remedies such as drinking of cranberry juice or ingestion of herbal remedies with a view to enhancing their immune response. Vaccine development remains a long way from human use and has yet to be developed for organisms other than Escherichia coli. The use of probiotics of restore the normal vaginal flora and provide a competitive bacterial barrier to pathogens is close to becoming available as an alternative preventive approach. The next decade should see the introduction of new methods for reduction of the high incidence of UTI and better management of recurring urogenital infections. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10654366> Lawson Research Institute, London, Ontario, Canada. gregor@julian.uwo.ca

• Reid G, Hsiehl J, Potter P, Mighton J, Lam D, Warren D and Stephenson J (2001). Cranberry juice consumption may reduce biofilms on uroepithelial cells: pilot study in spinal cord injured patients. Spinal Cord. 39 (1): 26-30. Summary: STUDY DESIGN: A pilot study of 15 spinal cord injured patients. Objective: To determine whether alteration of fluid intake and use of cranberry juice altered the bacterial biofilm load in the bladder. SETTING: London, Ontario, Canada. METHODS: Urine samples were collected on day 0 (start of study), on day 7 following each patient taking one glass of water three times daily in addition to normal diet, and on day 15 following each patient taking one glass of cranberry juice thrice daily. One urine sample was sent for culture and a second processed to harvest, examine by light microscopy and Gram stain non-squamous uroepithelial cells to generate bacterial adhesion per 50 cells data. RESULTS: The results showed that cranberry juice intake significantly reduced the biofilm load compared to baseline (P=0.013). This was due to a reduction in adhesion of Gram negative (P=0.054) and Gram positive (P=0.022) bacteria to cells. Water intake did not significantly reduce the bacterial adhesion or biofilm presence. CONCLUSION: The findings provide evidence in support of further, larger clinical trials into the use of functional foods, particularly cranberry juice, to reduce the risk of UTI in a patient population highly susceptible to morbidity and mortality associated with drug resistant uropathogens. SPONSORSHIP: This study was funded by Ocean Spray Cranberries, Lakeville, MA, USA. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11224011> Lawson Health Research Institute, London, Ontario, Canada.

• Schlager TA, Anderson S, Trudell J and Hendley JO (1999). Effect of cranberry juice on bacteriuria in children with neurogenic bladder receiving intermittent catheterization. J Pediatr. 135 (6): 698-702. Summary: OBJECTIVE: To determine the effect of cranberry prophylaxis on rates of bacteriuria and symptomatic urinary tract infection in children with neurogenic bladder receiving clean intermittent catheterization. DESIGN: Double-blind, placebo-controlled, crossover study of 15 children receiving cranberry concentrate or placebo concentrate for 6 months (3 months receiving one concentrate, followed by 3 months of the other). Weekly home visits were made. During each visit, a sample of bladder urine was obtained by intermittent catheterization. Signs and symptoms of urinary tract infection and all medications were recorded, and juice containers were counted. RESULTS: During consumption of cranberry concentrate, the frequency of bacteriuria remained high. Cultures of 75% (114 of 151) of the 151 samples obtained during consumption of placebo were positive for a pathogen (>/=10(4) colony- forming units/mL) compared with 75% (120 of 160) of the 160 samples obtained during consumption of cranberry concentrate. Escherichia coli remained the most common pathogen during placebo and cranberry periods. Three symptomatic infections each occurred during the placebo and cranberry periods. No significant difference was observed in the acidification of urine in the placebo group versus the cranberry group (median, 5.5 and 6.0, respectively). CONCLUSION: The frequency of bacteriuria in patients with neurogenic bladder receiving intermittent catheterization is 70%; cranberry concentrate had no effect on bacteriuria in this population. <http://www.ncbi.nlm.nih.gov/htbin-po...r&uid=10586171
http://www1.mosby.com/scripts/om.dll...02375&target=> University of Virginia, Department of Pediatrics and Emergency Medicine, Charlottesville 22906-0014, USA.

Interesting articles Dr. Young. I noticed the only study that determined a positive connection between cranberry juice consumption and a reduction in UTI was sponsored by Ocean Spray.
I have one further question. What does gram positive and gram negative mean?

[Wise Young]

Balley, actually the study from Hawaii showed a positive effect of cranberry juice and was, to my knowledge, not funded by a manufacturer.

Gram-positive refers to bacteria that have a carbohydrate coating on the outside and are stained black when they are exposed to iodine. Gram refers to the name of the person who developed this stain for bacteria. Most gram-positive bacteria are sensitive to penicillin-like antibiotics. Gram-negative refers to bacteria that do not stain with the gram stain. They are frequently resistant to penicillin and require other antibiotics such as those of the tetracycline family.

Of course, bacteria have evoled resistance to antibiotics almost as fast as we have been able to make new ones. There is a general fear amongst scientists that bacteria will win out in the long run. The great weakness of antibiotics is that they kill the ones that are sensitive to the antibiotics and the surviving bacteria are resistant. Note that this is the main reason why people must finish their course of antibiotics even though the symptoms go away because it just enourages more survivors and therefore more rapid development of resistance.

Wise.