Chinese herbal medicine for recurrent urinary tract infection: formulation-specific clinical evidence, experimental pharmacology, and unresolved recurrence mechanisms
Year: 2026
Type: review
Study design: Systematic Review
Abstract: Ethnopharmacological relevance Chinese herbal medicine (CHM) is used for recurrent or chronic urinary symptoms within the traditional category of dysuria, often through stage-specific treatment during symptomatic and remission phases. Whether defined CHM preparations prevent recurrent bacterial cystitis or modify recurrence biology remains uncertain. The aim of this study is to critically evaluate formulation-specific clinical evidence for CHM in women with recurrent urinary tract infection (rUTI) and determine whether reported benefits are connected to recurrence biology. Materials and methods Structured searches of PubMed, China National Knowledge Infrastructure, and Wanfang Data were closed on 13 July 2026. After within-batch screening and cross-source reconciliation, 103 reports were linked into 96 study or unresolved-report clusters. Clusters were classified by directness, and clinical confidence was appraised using allocation, participant flow, recurrence ascertainment, denominator integrity, comparator, intervention identity, safety reporting, internal consistency, and report independence. Results Ten core clusters directly addressed prospective recurrence or suppressive treatment, but every comparative estimate was of very low confidence. Reported signals were formulation-specific and were limited by attrition, responder-conditioned denominators, active comparators, co-interventions, poorly defined recurrence, internal numerical inconsistencies, or report linkage. Botanical identity and study-batch chemistry were usually inadequate. Experimental studies supported anti-adhesion, virulence-modulating, anti-inflammatory, immune, and urothelial plausibility, including chemically characterized Persicaria capitata extract and more specific Caveolin-1 evidence for purified cynaroside, but predominantly used acute or pretreatment models. No microbiome or biomarker study evaluated clinical mediation. Conclusion Current evidence is inconclusive rather than uniformly negative and supports cautious hypothesis generation for specific preparations, not a class-wide efficacy or safety claim. No clinical study demonstrates that CHM reduces recurrence by clearing persistent uropathogens, interrupting gut–bladder or vaginal transmission, restoring microbial ecology, or repairing the urothelial barrier. Reproducible products, intention-to-treat recurrence trials, longitudinal strain-resolved sampling, and prespecified mediation analyses are required.
Source: Frontiers in Pharmacology
Authors: Pengtian Zhang, Xuming Zhang, Chaoyue Ji, Weiguo Hu
Institutions: Beijing Tsinghua Chang Gung Hospital, Tsinghua University
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223268774