urinary tract infections ( utis ) account for 8.3 million doctor visits yearly in the united states and are the second most common type of infection in the body .
it is one of the most serious health problems affecting millions of people each year .
utis include acute as well as chronic cystitis , prostatitis , pyelonephritis , and urethritis .
lower urinary tract infection is more common among women with an incidence of one in five women at any point throughout their life .
men are usually devoid of utis , but sometimes due to an obstruction such as a stone or enlarged prostate they experience this .
prevalence of utis in men under 50  years is uncommon . although most of the cases of uti are asymptomatic or with a few distressing complaints like frequency , urgency of urination , pain during urination , difficulty in passing urine , and feeling of heaviness or pain in the pubic region even at rest , different anatomic ( obstructing lesions ) and physiologic ( estrogen deficiency , genetic factors , and regular antibiotic coverage ) factors are predisposing factors for utis .
anal intercourse and hiv infection also contribute to infection of urinary tract [ 3 , 4 ] .
the majority of causative organisms of uti are gram - negative bacteria in which escherichia coli alone contribute to 80 percent of cases .
proteus mirabilis , klebsiella pneumonia , and enterobacter aerogenes are also involve in the pathogenesis of the disease .
gram - positive bacteria include staphylococcus saprophyticus ( 1015% ) , enterococci , and staphylococcus aureus ( associated with calculi and catheterization ) .
microbiologically , uti is defined as presence of at least 10 organisms / ml of urine in an asymptomatic patient or as more than 100 organisms / ml of urine in a symptomatic patient with accompanying pyuria ( > 5  wbcs / ml ) .
conventional antibiotics are the first choice in an acute episode of uti ; therefore resistance of pathogenic bacteria to antibiotics is of high clinical concern .
the concept of the control of drug resistance is rather widely held today [ 6 , 7 ] .
several reports are available about the multidrug resistance of bacteria especially staphylococcus , pseudomonas , and escherichia
. therefore the world looks at some alternative and effective medicine particularly of natural origin .
some of the clinical studies recommend that mannose , cranberry , and probiotics can be natural options for long - term prevention from utis .
ayurveda and some other conventional systems of medicines state that plants are main reservoirs of natural entities which have been used for the treatment of different ailments .
it was reported that over 70% of the indian people believe in nature for their food as well as medicines .
the moringaceae is a single - genus family of oil seed trees with 14 well known species .
moringa oleifera , commonly known as horseradish tree or drumstick tree and saijan in hindi , ranges in height from 5 to 10  m [ 9 , 10 ] .
it is indigenous to sub - himalayan regions of northwest india , africa , arabia , southeast asia , and the pacific and caribbean islands .
the drumstick tree was used as food and medicine for centuries ; it is only recently that scientific basis for these uses has been recognized .
the stem bark has been reported to contain two alkaloids , namely , moringine and moringinine , vanillin , -sitosterol , -sitostenone , 4-hydroxymellin , and octacosanoic acid   and phenolics .
its bark possesses antibacterial [ 1521 ] activities against varieties of both gram - positive and gram - negative bacteria , antifungal , anticholesteremic , antilipidemic , antifertility , anti - inflammatory , diuretic , antiurolithiatic , antioxidant , antisickling , cardioprotective , hepatoprotective , and hypoglycaemic   effect .
the aim of the present study was to find out the efficacy of m. oleifera stem bark as a potential treatment for urinary tract infection .
a total of 30 patients were registered from the dravyaguna out patient department , ayurveda wing , sir sunderlal hospital , institute of medical sciences , banaras hindu university , varanasi , after proper screening on the predesigned pro forma .
the cases were selected , also , on the basis of the following inclusion ( adult , uncomplicated uti , and patients with bph ) and exclusion ( patients with renal failure , calculus , and stricture or any structural pathology and pregnant women ) criteria . then all the cases are screened for other possible causes of uti before including in the final sample .
the work has been approved by the ethical committee of the institute of medical sciences , banaras hindu university , varanasi ( ref : dean/2010 - 11/92 dated : 5th may 2010 ) .
identification of drug was carried out in the department of dravyaguna , faculty of ayurveda , institute of medical sciences , banaras hindu university , varanasi .
the stem bark is powdered coarsely for decoction in ayurvedic pharmacy , faculty of ayurveda , institute of medical sciences , banaras hindu university , varanasi .
30 patients with uti were randomized and divided into two groups , 15 patients in each .
one group is treated with trial drug shigru bark decoction ; 40  ml ( made by boiling 15  g of coarse powder in 100  ml water ) for 21 days , twice daily , is given to patients for treatment ; another group was named control group in which standard modern medication was administered . to assess the effect ,
but after getting investigations and effect of the drugs on subsequent follow - ups ( responding / not responding ) , these cases were classified also as per the characteristic of urine , sign / symptoms concerned with the specific pathogen grown in the urine .
patients were also advised to drink lukewarm water , avoid sexual intercourse , suppression of natural urge of urination , exercise , excessive speech , uneven sitting and lying postures , exposure to wind , cold , heat , and dust , anger , and grief .
patients of both groups were advised to come for follow - up every 7 days . at every follow - up changes in clinical features were noted and the investigations were repeated .
the patient of test group was advised to continue the oral medication that was continued for the next 7 days . in control group patients
were advised to continue the prescribed antibiotic in the therapeutic doses for the duration of the next 15 days .
all these patients were followed for at least two months . those cases with a minimum of the three follow - ups or who had minimum treatment for duration of one and half months were included for analysis of result .
assessment was made on the following criteria during follow - up : changes in clinical symptomatology ( table 1);finding in the routine and microscopic examination of urine;finding in urine culture .
changes in clinical symptomatology ( table 1 ) ; finding in the routine and microscopic examination of urine ; finding in urine culture .
results on continuous measurements are presented on mean  sd and results on categorical measurements are presented in number ( % ) .
the age distribution of the patients in the sample set was 2565 years ( mean age of 36.16 ) .
the prevalence of uti was highest within 2535 years ( 30% ) followed by 3545 years ( 20% ) , 1525 years ( 20% ) , 4555 years ( 16.67% ) , and 5565 years ( 13.33% ) .
the majority of cases were female ( 56.67% ) and 43.33% of cases were male patients which is in agreement with earlier studies [ 3135 ] .
the peculiarities of female anatomy with shorter urethra and closeness of the urethral meatus and anus have been reported as factors which influence the higher prevalence in women .
the age group analysis showed that young patients usually female in the range of 2535 years had high prevalence rate of uti .
this result is in agreement with previous studies [ 37 , 38 ] which shows that among sexually active young women the incidence of symptomatic uti is high and the threat is firmly connected with sexual intercourse , fresh utilization of diaphragm with spermicide , and a positive history of recurrent utis .
the majority of cases were married ( 70% ) , followed by 7 ( 23.33% ) unmarried and 2 ( 6.67% ) widows .
the majority of cases were hindu ( 90% ) ; only 10% of cases were muslim as circumcision seems to reduce the overall incidence of uti in muslims .
prevalence of disease is highest in business and housewife ( both 26.67% ) then followed by student ( 16.67% ) farmers ( 13.33% ) , service class ( 10% ) and unemployed ( 6.66% ) [ 40 , 41 ] .
the majority of cases belonged to rural area ( 53.33% ) followed by urban area ( 46.67% ) .
a maximum number of cases are from the disease that were of middle class ( 73.33% ) followed by lower ( 20% ) and upper ( 6.67% ) .
it was observed that total duration of illness ranged from 6 month-1 year ( 33.33% ) to 5 years ( 13.33% )
. clinical profile of these patients exhibited fever ( 80% ) , oliguria ( 70% ) , burning urination ( 66.67% ) , frequency ( 63.33% ) , pain , and urgency ( 60% ) .
routine and microscopic urine examination of these patients at starting of treatment exhibited sugar ( 53.33% ) , albumin ( 50% ) , rbc ( 33.33% ) , epithelium ( 26.67% ) , pus cell ( 30% ) 10% patients with crystals . in our study gram - negative aerobic rods predominated , among which e. coli was the commonest uropathogen responsible for uti .
it accounted for 60.0% of all positive cultures , while k. pneumoniae and proteus mirabilis were the next most common organisms , accounting for 16.67% and 10% of culture in the present study , respectively .
pseudomonades aeruginosa , streptococcus faecalis , and staphylococcus aureus are also present in some of the patients ( table 2 ) .
the percentage of causative bacterial class was analogous to some other previous studies [ 4347 ] . in our study
we found that fever was absent in only 6.67% of cases at the end of treatment in test group ; however a gradual decrease in the number of patients has been observed ( table 3 ) .  
table 4 reveals therapeutic effect within both groups in successive follow - ups , which is highly significant in group a ( p < 0.001 ) and significant in group b ( p < 0.005 ) after treatment ( at ) .
initial mean reduced from 2.88  0.719 to 2.31  0.704 after treatment regimen in group a and from 3.25  0.577 to 2.75  0.683 in group b. intergroup comparison between before treatment ( bt ) and after treatment ( at ) was not found to be significant .
it means that the tested drug is effective in controlling fever but it is not as effective as antibiotics .
successful reduction in burning sensation during urination was observed ( table 3 ) in both groups . only in 26.67% of cases burning urination
was relieved at the end of treatment in group a , while 6.67% of cases were relieved from the complaint at in group b.   table 4 showed effect on burning urination in both groups on successive follow - ups which is highly significant in group a ( p < 0.001 ) and significant in group b ( p < 0.005 ) .
it means that the tested drug is effective in controlling the burning sensation during urination but not as effective as antibiotics .
relief from pain during urination is observed in both groups . in 40% of cases pain
was completely relieved at the end of treatment in group a. in group b , 6.67% of cases were relieved from the complaint at ( table 3 ) .  
table 4 showed significant changes in relieving pain in both groups in successive follow - ups ( p < 0.01 ) . in 6.67% of cases , frequency of urination was normalized at the end of treatment in group a. in group b , 6.67% of cases were relieved from the complaint at ( table 3 ) .  
table 4 showed significant changes in frequency in both groups in successive follow - ups ( p < 0.05 ) .
improvement in amount of urine is also observed in both groups . in 6.67% of cases ,
oliguria was relieved at the end of treatment in group a. in group b , 6.67% of cases were relieved from the complaint at ( table 3 ) .  
table 4 showed significant improvement in oliguria disorder in both groups in successive follow - ups ( p < 0.05 ) .
the routine and microscopic urine examination of these patients after treatment showed significant effect of the test drug . pus cell and
the culture reports showed that the herb has prominent effect on e. coli and other bacteria like k. pneumoniae and p. mirabilis .
however , p. aeruginosa , s. faecalis , and s. aureus were not found to be present in any of the patients at the end of the treatment .
as evident from table 5 , the majority of cases were cured ( 56.67% ) after three weeks of treatment , followed by improving ( 20% ) and relapsing ( 13.33% ) .
this study was conducted on volunteer patients in the department of dravyaguna , faculty of ayurveda , institute of medical sciences , banaras hindu university , varanasi , india , spread over a period of one and half years .
the study was carried out according to the institution guidelines for biomedical research involving human subjects .
our data show that decoction of m. oleifera is an effective remedy for symptomatic relief in utis .
this is an encouraging result which clearly favors promotion of m. oleifera as a remedy among rural communities especially belonging to low socioeconomic strata as m. oleifera is easily accessible and is cheap and safe .
the results demonstrated a significant reduction of symptoms in both groups a and b over a period of two months .
levofloxacin has been utilized for several years and it is still considered one of the most effective agents in utis . however , recurrence is quite common ; therefore new drugs from herbal origin with similar or superior efficacy and possibly fewer long - term effects need to be investigated .
m. oleifera is one of the common indian herbs used for different conditions related to urinary system such as urolithiasis and benign prostrate hyperplasia .
this plant has been used in india and other parts of asia for thousands of years for nutritional as well as medical purposes . in traditional literature , preparations of the m. oleifera
stem bark of m. oleifera has been tested against a variety of microorganisms like e. coli , s. aureus , b. cereus , p. aeruginosa , and p. mirabilis .
it shows prominent effect against e. coli ( mic 64  g / ml ) , which is a major causative factor in the utis . in the present study , m. oleifera decoction provides symptomatic relief to the patients during the trial ; possible explanation for this effect might be due to the antibacterial and anti - inflammatory agents present in the plant [ 15 , 1721 , 23 ] .
urinary stone is also one of the conditions which facilitate utis ; therefore antiurolithiatic activity   of drumstick might also contribute in its action on urinary system .
urinary tract infection in addition aggravates the oxidative stress in some cases like diabetes   and pregnancy .
so antioxidant activity   of m. oleifera bark is effective against oxidative stress produced in uti probably because of phenolic component .
painful and inconvenient , a uti results in frequent urges to urinate with little production of urine and is accompanied by a severe burning sensation .
diuretic abilities of moringa also appear to inhibit adheration of infection - causing bacteria to the wall of the bladder , so they are sloughed off in urine as reported in the similar case of cranberry .
however , as this is the first attempt to assess the effect of m. oleifera in utis , clinical trial of longer duration with a larger sample size should play a vital role in commercialization of m. oleifera .
from the clinical study , it has been concluded that stem bark of m. oleifera , at a dose of 40  ml bd , is effective on most of the cardinal symptoms of urinary tract infection .
the drug was well tolerated and does not generate any adverse effect during the entire clinical study .
the drug is also helpful in eradicating urinary pathogens like e. coli that are responsible for uti .
 
 objective . 
 urinary tract infections ( uti ) are the most common problem in clinical practice . usually they are asymptomatic and are commonly present with distressing symptoms like pain and burning sensation on urination . 
 antibiotics are widely used to treat utis ; however , they have their own limitations like resistance , reinfection , and relapses . the purpose of the current study was to evaluate the value of moringa oleifera lam . 
 stem bark as a potential medicine for utis 
 . study design . 
 30 patients with uti were randomly divided into two groups with 15 patients in each group . 
 shigru bark was given to patients of the first group ( trial group ) and modern medicines were prescribed to the other group of patients . 
 at least three follow - ups are taken in both groups at the end of every week of treatment . 
 results . 
 after treatment 66.67 % were cured , 13.33 % improved , 13.33% patients have no change , and 6.67% relapsed in trial group and in control group 46.67% were cured , 26.66% improved , 6.67% patients have no change , and 20% relapsed . interpretation and conclusion . 
 the trial drug is significant in the management of uti . 
 this study needs to be done on a large scale and for a long time . 
1. Introduction 
2. Material and Methods 
3. Result and Discussion
4. Conclusion