Reviewed: Kamalifard M, Abbasalizadeh S, Mirghafourvand M, et al. The effect of Seidlitzia rosmarinus (eshnan) on the prevention of recurrent cystitis in women of reproductive age: A randomized, controlled, clinical trial. Phytother Res. February 2020;34(2):418-427. doi: 10.1002/ptr.6534.

Cystitis is a symptomatic acute or chronic bladder infection often caused by Escherichia coli bacteria. Recurrent cystitis is the occurrence of the infection twice or more in six months or three or more times in 12 months. Some herbal medicines are used to treat and control recurrent cystitis. Eshnan (Seidlitzia rosmarinus, Amaranthaceae) is reported to have antibacterial, anti-inflammatory, antiseptic, anti-urinary retention, and diuretic effects. The authors conducted a randomized, triple-blind, controlled trial to determine the efficacy of eshnan for preventing the incidence of recurrent cystitis.

The study included 126 women who had been diagnosed with recurrent cystitis at any of the health centers in Parsabad, Iran, between October 2017 and November 2018. They had not taken antibiotics during the month before the study and were not taking immune system-suppressing medications. All patients had to have clinical symptoms of a urinary tract infection (UTI) and negative urine cultures (absence of bacterial infection) to be included in the study. Those with positive urine cultures were treated for cystitis with antibiotics, tested again a week after finishing the medication, and enrolled in the study if the test was negative. The patients were randomly assigned to the eshnan and placebo groups, with 63 in each group. Mean ages were 36.1 years in the eshnan group and 36.7 years in the placebo group.

Eshnan purchased from an herbal store was dried and ground. The authors analyzed the chemical composition of the ground herb, but they did not describe the authentication of the material in the paper. Capsules were filled with 500 mg of either the ground eshnan powder or starch as the placebo. The patients were instructed to take three capsules 30 minutes after each meal daily for two months. They were followed for four months after completing the study medications. During weekly phone calls, the patients were asked about medication intake, adverse effects, and cystitis symptoms.

After two, four, and six months, patients were assessed for clinical symptoms of recurrent cystitis, and urine samples were collected and tested. Any patients with clinical symptoms of cystitis at any time during the study underwent evaluations; those with positive cultures received the appropriate antibiotics “so as to continue the intervention,” the authors explained. Patients with symptoms and positive cultures twice or more during the study were given a “definitive diagnosis” of recurrent cystitis, referred to a physician for treatment, and followed up with until the end of the study. Five patients in the eshnan group and four patients in the placebo group did not attend the follow-up visits and were not included in the final analyses.

Sociodemographic and personal health data were similar between the two groups. Cystitis was diagnosed in 11 (19%) patients from the eshnan group and 32 (55.2%) from the placebo group by the second month; in 13 (22.4%) patients from the eshnan group and 33 (56.9%) from the placebo group by the fourth month; and in 19 (32.8%) patients from the eshnan group and 43 (72.9%) from the placebo group by the sixth month (P < 0.001 for all time points). Eight (13.8%) patients in the eshnan group and 39 (66.1%) in the placebo group were diagnosed with recurrent cystitis (P < 0.001) during the study.

After two months of intervention, the eshnan group experienced a significantly lower incidence of frequent urination (P = 0.002) and dysuria (painful urination; P < 0.001) compared with the placebo group. After four months, frequent urination (P = 0.001) and suprapubic pain (P = 0.027) were significantly reduced in the eshnan group compared with the placebo group. After six months, compared with the placebo group, the eshnan group had significantly lower incidences of frequent urination (P < 0.001), dysuria (P = 0.020), and oliguria (the production of abnormally small amounts of urine; P = 0.005). No adverse effects were reported in either group.

Because this study was conducted in healthy, nonpregnant, and nonlactating women of reproductive age, the results cannot be generalized to women of other age groups or to pregnant and lactating women. Also, because the participants’ medication intake, side effects, and cystitis symptoms were assessed during phone calls with the researchers, the results may have been influenced by self-reporting biases.

The authors concluded that eshnan significantly reduced the incidence of recurrent cystitis and alleviated the symptoms. “Given the benefits of this plant in terms of preventing the incidence of cystitis without causing any side effect[s], the harmful effects of chemical medications, and the growing use of herbal medicines, this plant can be used to prevent the incidence of recurrent cystitis and reduce its complications and also to reduce the prevalence of multi-drug resistance in UTI treatment,” they wrote.