{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:35:11Z","timestamp":1782300911701,"version":"3.54.5"},"reference-count":35,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,2]],"date-time":"2024-11-02T00:00:00Z","timestamp":1730505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Repha GmbH Biologische Arzneimittel, Langenhagen, Germany"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: The goal of this study was to evaluate whether the medical recommendation of Angocin\u00ae\u00a0Anti-Infekt N, compared to standard antibiotic treatment shortly after the diagnosis of a urinary tract infection (UTI) or cystitis, is negatively associated with an early, sporadic, or recurrent UTI, subsequent antibiotic prescriptions, pyelonephritis as a renal complication, or UTI-associated sick leave. Methods: This retrospective cohort study was based on data from the IQVIATM Disease Analyzer database and included patients diagnosed with acute UTI or cystitis by physicians in Germany between 2005 and 2021, who were prescribed either Angocin\u00ae or standard antibiotics within 4 days after diagnosis. Patients prescribed antibiotics were matched to those prescribed Angocin\u00ae (5:1) using propensity scores. Univariable logistic and Cox regression models were used to investigate the association between Angocin\u00ae prescription and the defined study outcomes. The effects of Angocin\u00ae were adjusted for age, sex, insurance status, index diagnosis, and physician specialty. Results: A total of 2277 Angocin\u00ae patients and 11,385 antibiotic patients were available for analysis. Compared to antibiotic prescriptions, Angocin\u00ae prescription was associated with significantly lower odds of an early relapse within 1\u201330 days after the index date (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.62\u20130.87; p &lt; 0.001), further sporadic UTI within 31\u2013365 days after the index date (OR: 0.68; 95% CI: 0.58\u20130.78; p &lt; 0.001), and recurrent UTI (OR: 0.63; 95% CI: 0.48\u20130.82; p &lt; 0.001). This was also accompanied by reduced antibiotic prescriptions (1\u201330 days: OR: 0.63; 95% CI: 0.53\u20130.74, p &lt; 0.001; 31\u2013365 days: OR: 0.56; 95% CI: 0.49\u20130.64, p &lt; 0.001). A strong, but due to the low incidence, not significant, negative association was observed between Angocin\u00ae prescription and the occurrence of pyelonephritis (hazard ratio (HR): 0.67; 95% CI: 0.43\u20131.06; p = 0.073). Conclusions: The results of this real-world data study demonstrate that Angocin\u00ae can be an effective therapeutic option for managing acute and recurrent UTIs and serves as an alternative therapy to antibiotics.<\/jats:p>","DOI":"10.3390\/antibiotics13111036","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T03:57:34Z","timestamp":1730692654000},"page":"1036","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness of a Combination of Nasturtium Herb and Horseradish Root (Angocin\u00ae\u00a0Anti-Infekt N) Compared to Antibiotics in Managing Acute and Recurrent Urinary Tract Infections: A Retrospective Real-world Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9464-3718","authenticated-orcid":false,"given":"Nina","family":"Kassner","sequence":"first","affiliation":[{"name":"Repha GmbH Biologische Arzneimittel, 30855 Langenhagen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3200-6867","authenticated-orcid":false,"given":"Meinolf","family":"Wonnemann","sequence":"additional","affiliation":[{"name":"Repha GmbH Biologische Arzneimittel, 30855 Langenhagen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7262-4517","authenticated-orcid":false,"given":"Yvonne","family":"Ziegler","sequence":"additional","affiliation":[{"name":"Repha GmbH Biologische Arzneimittel, 30855 Langenhagen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winfried","family":"Vahlensieck","sequence":"additional","affiliation":[{"name":"Stresemannstr, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Kranz","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, RWTH Aachen University, 52074 Aachen, Germany"},{"name":"Department of Urology and Kidney Transplantation, Martin-Luther-University, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-7227","authenticated-orcid":false,"given":"Karel","family":"Kostev","sequence":"additional","affiliation":[{"name":"IQVIA Epidemiology, 60549 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/nrmicro3432","article-title":"Urinary tract infections: Epidemiology, mechanisms of infection and treatment options","volume":"13","author":"Walker","year":"2015","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1159\/000487645","article-title":"The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients. Part II: Therapy and Prevention","volume":"100","author":"Kranz","year":"2018","journal-title":"Urol. Int."},{"key":"ref_3","first-page":"Doc01","article-title":"Psychosocial burden of recurrent uncomplicated urinary tract infections","volume":"10","author":"Naber","year":"2022","journal-title":"GMS Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.eururo.2024.03.035","article-title":"European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines","volume":"86","author":"Kranz","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_5","unstructured":"Deutsche Gesellschaft f\u00fcr Urologie e.V. (2024). S3 Leitlinie: Epidemiologie, Diagnostik, Therapie, Pr\u00e4vention und Management Unkomplizierter, Bakterieller, Ambulant Erworbener Harnwegsinfektionen bei Erwachsenen\u2014Aktualisierung 2024. Langversion, 3.0, AWMF Registernummer: 043\/044. 3 Guideline: Epidemiology, Diagnosis, Therapy, Prevention and Management of Uncomplicated Bacterial Community-Acquired Urinary Tract Infections in Adults\u2014Update 2024. Long Version, 3.0, AWMF Register Number: 043\/044, Deutsche Gesellschaft f\u00fcr Urologie."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1016\/j.cmi.2022.06.017","article-title":"Reducing antibiotic use in uncomplicated urinary tract infections in adult women: A systematic review and individual participant data meta-analysis","volume":"28","author":"Kaussner","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_7","first-page":"1","article-title":"Urinary tract infections in the elderly: A review of disease characteristics and current treatment options","volume":"9","year":"2020","journal-title":"Drugs Context"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"654","DOI":"10.5414\/CP204057","article-title":"Prevalence of and factors associated with the prescription of phytopharmaceuticals in outpatients with urinary tract infections","volume":"59","author":"Ehrenberg","year":"2021","journal-title":"Int. J. Clin. Pharmacol. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/BF02552109","article-title":"Nitrofurantoin versus trimethoprim for low-dose long-term prophylaxis in patients with recurrent urinary tract infections. A prospective randomized study","volume":"24","author":"Vahlensieck","year":"1992","journal-title":"Int. Urol. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"344.e1","DOI":"10.1016\/j.cmi.2014.11.016","article-title":"Collateral damage from oral ciprofloxacin versus nitrofurantoin in outpatients with urinary tract infections: A culture-free analysis of gut microbiota","volume":"21","author":"Stewardson","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_11","first-page":"Doc05","article-title":"Antibiotic consumption and resistance of gram-negative pathogens (collateral damage)","volume":"6","author":"Cizman","year":"2018","journal-title":"GMS Infect. Dis."},{"key":"ref_12","first-page":"175","article-title":"The Percentage of Antibiotic Resistance in Uncomplicated Community-Acquired Urinary Tract Infections","volume":"121","author":"Klingeberg","year":"2024","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1111\/j.1469-0691.2011.03519.x","article-title":"Active surveillance of antibiotic resistance prevalence in urinary tract and skin infections in the outpatient setting","volume":"17","author":"Kronenberg","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Schmiemann, G., Hoffmann, F., Hamprecht, A., and Jobski, K. (2022). Patterns and trends of antibacterial treatment in patients with urinary tract infections, 2015\u20132019: An analysis of health insurance data. BMC Prim. Care, 23.","DOI":"10.1186\/s12875-022-01816-6"},{"key":"ref_15","first-page":"842","article-title":"In-vitro-Untersuchungen zur antibakteriellen Wirksamkeit einer Kombination aus Kapuzinerkressekraut (Tropaeoli majoris herba) und Meerrettichwurzel (Armoraciae rusticanae radix)","volume":"56","author":"Conrad","year":"2006","journal-title":"Drug Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1055\/s-0032-1331754","article-title":"Broad spectrum antibacterial activity of a mixture of isothiocyanates from nasturtium (Tropaeoli majoris herba) and horseradish (Armoraciae rusticanae radix)","volume":"63","author":"Conrad","year":"2013","journal-title":"Drug Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1950692","DOI":"10.1155\/2017\/1950692","article-title":"Evaluation of an Aqueous Extract from Horseradish Root (Armoracia rusticana Radix) against Lipopolysaccharide-Induced Cellular Inflammation Reaction","volume":"2017","author":"Herz","year":"2017","journal-title":"Evid. Based Complement. Alternat Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.phymed.2016.02.025","article-title":"Nasturtium (Indian cress, Tropaeolum majus nanum) dually blocks the COX and LOX pathway in primary human immune cells","volume":"23","author":"Tran","year":"2016","journal-title":"Phytomedicine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s15010-019-01315-4","article-title":"In vitro efficacy of phytotherapeutics suggested for prevention and therapy of urinary tract infections","volume":"47","author":"Marcon","year":"2019","journal-title":"Infection"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.fitote.2018.07.012","article-title":"Treating urinary tract infections due to MDR E. coli with Isothiocyanates\u2014A phytotherapeutic alternative to antibiotics?","volume":"129","author":"Mutters","year":"2018","journal-title":"Fitoterapia"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.fitote.2017.04.006","article-title":"Natural isothiocyanates express antimicrobial activity against developing and mature biofilms of Pseudomonas aeruginosa","volume":"119","author":"Kaiser","year":"2017","journal-title":"Fitoterapia"},{"key":"ref_22","first-page":"249","article-title":"Wirksamkeit und Vertr\u00e4glichkeit eines pflanzlichen Arzneimittels mit Kapuzinerkressenkraut und Meerrettich bei akuter Sinusitis, akuter Bronchitis und akuter Blasenentz\u00fcndung im Vergleich zu anderen Therapien unter den Bedingungen der t\u00e4glichen Praxis","volume":"56","author":"Goos","year":"2006","journal-title":"Arzneimittelforschung"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.1185\/030079907X233089","article-title":"A randomised, double-blind, placebo-controlled trial of a herbal medicinal product containing Tropaeoli majoris herba (Nasturtium) and Armoraciae rusticanae radix (Horseradish) for the prophylactic treatment of patients with chronically recurrent lower urinary tract infections","volume":"23","author":"Albrecht","year":"2007","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"459","DOI":"10.5414\/CP203320","article-title":"Basic characteristics and representativeness of the German Disease Analyzer database","volume":"56","author":"Rathmann","year":"2018","journal-title":"Int. J. Clin. Pharmacol. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Holler, M., Steindl, H., Abramov-Sommariva, D., Wagenlehner, F., Naber, K.G., and Kostev, K. (2021). Treatment of Urinary Tract Infections with Canephron ((R)) in Germany: A Retrospective Database Analysis. Antibiotics, 10.","DOI":"10.3390\/antibiotics10060685"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"167","DOI":"10.5414\/CP204177","article-title":"Association between contraceptive use and risk of lower urinary tract infection (LUTI): A case-control study","volume":"60","author":"Heidemann","year":"2022","journal-title":"Int. J. Clin. Pharmacol. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1002\/pds.3263","article-title":"One-to-many propensity score matching in cohort studies","volume":"21","author":"Rassen","year":"2012","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S84","DOI":"10.1016\/j.jclinepi.2013.01.013","article-title":"Prognostic score-based balance measures can be a useful diagnostic for propensity score methods in comparative effectiveness research","volume":"66","author":"Stuart","year":"2013","journal-title":"J. Clin. Epidemiol."},{"key":"ref_29","first-page":"100257","article-title":"Self-care and self-medication as central components of healthcare in Germany\u2014On the way to evidence-based pharmacy","volume":"9","author":"Bertsche","year":"2023","journal-title":"Explor. Res. Clin. Soc. Pharm."},{"key":"ref_30","first-page":"238","article-title":"Aktuelle Untersuchungen zur Wirksamkeit und Vertr\u00e4glichkeit eines pflanzlichen Arzneimittels mit Kapuzinerkressenkraut und Meerrettich bei akuter Sinusitis, akuter Bronchitis und akuter Blasenentz\u00fcndung bei Kindern im Vergleich zu anderen Antibiotika","volume":"57","author":"Goos","year":"2007","journal-title":"Arzneimittelforschung"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.fitote.2012.12.016","article-title":"Determination of bioactive, free isothiocyanates from a glucosinolate-containing phytotherapeutic agent: A pilot study with in vitro models and human intervention","volume":"85","author":"Marton","year":"2013","journal-title":"Fitoterapia"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1038\/s41385-022-00549-0","article-title":"The impact of biological sex on diseases of the urinary tract","volume":"15","author":"Deltourbe","year":"2022","journal-title":"Mucosal Immunol."},{"key":"ref_33","unstructured":"Sabih, A., and Leslie, S.W. (2024). Complicated Urinary Tract Infections. StatPearls, StatPearls Publishing."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.pop.2019.01.001","article-title":"Cystitis and Pyelonephritis: Diagnosis, Treatment, and Prevention","volume":"46","author":"Kolman","year":"2019","journal-title":"Prim. Care"},{"key":"ref_35","first-page":"173","article-title":"Acute Pyelonephritis in Adults: Rapid Evidence Review","volume":"102","author":"Herness","year":"2020","journal-title":"Am. Fam. Physician"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/11\/1036\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:27:17Z","timestamp":1760113637000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/11\/1036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,2]]},"references-count":35,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["antibiotics13111036"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13111036","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,2]]}}}