Dr Shankar

for the use only of registered medical practitioners or a hospital or a laboratory

for the use only of a registered medical practitioner or a hospital or a laboratory

BANGSHIL IN MANAGEMENT OF URINARY

TRACT INFECTIONS

By

Dr. Avinash Shanker, MBBS, DCH., DR. PED., FRCP., MNAMS., Ph.D., FNCP., FACP Medical Director, R.A. Hospital & Research Centre, Warisaliganj (Nawala), Bihar

 

Paper presented at: 3rd International Congress on Traditonal     -

The Medicine and surgery PP13-16, July -Aug 1990 Asian medicine, held at Bombay 4th to 7th Jan. 1990

ABSTRACT:

The efficacy & safety of BANGSHIL in dosage of 2 tabs every 8 hours in adults and 1 tab every`8 hours in children (5 to 10 years) for 14 days followed with half dose for next 21 days in 68 fresh cases of Urinary tract infection and 72 of chronic recurrent UTI with drug defaulter were evaluated. It revealed that 100% of patients showed complete resolution of signs and symptoms with bacteriological elimination in 14 days therapy without any local or systemic adverse effects.

During post therapy follow up no recurrence or relapse was reported. Hence BANGSHLL administration in UTI management was found effective and safe.

         

INTRODUCTION:

Urinary Tract Infection (UTI) is one of the commonest disease in all age groups & presents with Recurrent fever with chills and/or rigor, fre­quency of micturition, Dysuria, Nocturia and costovertebral pain are some of the common features of UTI.

 

Due to non availability of culture facilities at the rural level, irregularity of dose schedule, compelling poverty to afford higher anti micro­bials and increasing drug resistance to com­monly used urinary antimicrobial agent i.e. Am­picillin, Cephalosporin, Chloremphenicol, Co trimoxazol, Hexamine - mandelate. Nalidixic acid Nitrofurantoin, Gentamycine, Sisomycine.

 

Hence, considering the clinical efficacy of BANGSHIL in varied urinary complaints and problems in management of UTI i.e.

a) Toxic side effects of broad spectrum antimic­robials.

b) Emergence of resistance strains.

c) Discouraging pattern of antibiotic sensitivity to causative pathogens.

 

BANGSHIL which constitutes the following has been evaluated in UTI management with

consideration to clinico pathological findings and safety margine.

Asphaltam (Shilajit)             60 mg.

Bang Bhasma                     80 mg.

Guggul                              40 mg.

Makshik Bhasma                 30 mg.

Kasis                                30 mg.

Elaichi, Taj, Tamalpatra,

Dantimool & Nasotar

and Banskapoor each 12 mg.

 

Sanchar, Sindahav, Sajikhar, Javkhar, Piper, Mari, Sunth, Galo, Vavding, Gaipipar, Chavak, Amala, Harda, Baheda, Chitrak mool, Ganthoda, Haldar, Daru Haldar, Ativish ni kali, Vacha, Devdaru, Nagarmoth, Karaitu, Kachuro, Bhelngro, Bhojpatra, Utpalsari, Chibhada no magaj, Galjibhi, Vaivaran ni chhal, Semal mool, Renukbeej, Jethimadh, Chinikabab, Saragawano mool

each   03 mg.

Excp.  Q.$.

 

PATIENTS AND METHODS:

140 patients of Urinary Tract Infection between 5 yrs. to 55 yrs. with established Urinary Tract Infection but normal renal function as judged by serum creatinine < 1:5 mg/dl and normal complete urinalysis, were enrolled in the study.

 

The patients were required to have a pre therapy urine culture with atleast 10 micro or­ganism/ml. The patients were classified in two groups. Group A-68, Fresh detected cases of urinary tract infection. Group B-72, Patients of Urinary-Tract Infection with drug defaulter. BANGSHIL 2 tabs. every 8 hrs. in adult and 1 tab. every 8 hrs. in pediatric patient (5 yrs -10 yrs.) for 14 days followed with half the dose for next 21 days was administered.

 

The presence of signs and symptoms of in­fection including fever, rigors, chills, dysuria, Nocturia, frequency of micturition and costover­tebral tenderness were assessed prior to therapy, atleast once every 3 days during therapy and post therapy at the completion of treatment, 1 week and 1 month after therapy.

 

In addition clinical response was graded as

Grade-I:        Complete resolution of signs and symptoms.

Grade-II:       Improvement  of       signs   and symptoms.

Grade-III:      Failure - Persistence in significant improvement of signs & symptoms after 72 hrs. of therapy.

 

Bacteriologic response was evaluated on the basis of culture obtained prior to and one week following completion of therapy. An addi­tional urine culture was obtained four weeks after completion of therapy.

 

Bacteriologic response included -

Elimination -             Absence of causative micro or­ganism or 105 micro organism/ml upon culture one week post therapy.

Recurrence -            Reappearance of the same micro organism at the follow up culture one month post therapy.

Persistance -           Presence of 105 micro or­ganism/ml upon culture one week post therapy.

 

Patients were carefully observed for therapy re­lated side effects throughout the study. A com­plete haemogram and test for renal function were performed prior to -and immediately upon completion of therapy.

 

RESULTS:

There were 98 males and 42 females who were included in the evaluation for efficacy, safety and tolerance of BANGSHIL in management of UTI. Patients characteristics are shown in Table 1. Prior to entry to this study all patients of group B had received treatment with antimicro­bial agents like Cephalosporin, Co trimoxazol, Hexamine mandelate Nalidixic acid, Nitrofuran­toin, Gentamycin and sisomycine. The duration of such treatment ranged from 10 days to 3 months whereas patients of Group A are fresh cases of UTI whose duration also ranged from 4 days to 7 days.

 

 

 

 

TABLE -1

Shows Age & Sexwise distribution of patients.

Age Group

Group-A

Male Female

Group-B

Male Female

5yrs-10yrs

7

1

-

-

10yrs-15yrs

4

3

12

11

15yrs-20yrs

4

-

5

2

20yrs-25yrs

3

1

2

0

25yrs-30yrs

4

2

6

2

30yrs-35yrs

7

2

8

3

35yrs-40yrs

9

3

2

4

40yrs-45yrs

4

-

5

3

45yrs-50yrs

5

1

0

1

50yrs-55yrs

6

2

5

1

 

53

15

45

27

M/F = 98/42   Group A/B = 68/72

 

 

TABLE-II

Shows Bacteriologic Profile.

Causative Pathogen

No.

Percentage

Esch. Coli

70

50%

KleibsiellaPneumonie

28

20%

Proteus Indole Positive

17

12.14%

Pseudomonas Aeruginosa

12

8.57%

Streptococcus Faecalis

9

6.42%

StaphylococcusAureus

4

2.87%

 

 

One organism was isolated from each patient irrespective of their disease state (Table - 2)

 

TABLE-III

Shows Clinical Outcome

Type of Response                          Number of Cases

 

Group A

After 72hrs. 14 days

Group B

After 72hrs.            14 days

Complete

56(68)

68(68)

39(72)

72(72)

Improved

12(68)

Nil

33(72)

Nil

Failure

None

None

None

None

 

TABLE-IV

Shows Bacteriologic Outcome

 

Type of Response     Number of Cases

 

Group A

7th day         14 days

Group B

7th day        14 days

Elimination

66

68

48

72

Recurrence

None

None

None

None

Persistance

02

None

24

None

 

100% of Group A and Group B patients shows complete resolution of signs and symptom by 14th day of BANGSHIL therapy, though 56/68 of Group A and 39/72 of Group B had clinical relief of the symptom after 72 hrs. of therapy. (Table 3).

 

The Bacteriological outcome parallelled the clinical response i.e. Urine culture revdals sterile in 66 (68) of Group A and 48 (72) of Group B on 7th day of therapy and on 14th day culture of urine shows sterile in all patients of Group A and B.

 

Repeat culture at 4 weeks post therapy de­monstrated that there was not a single instance of recurrence in any of the patients who earlier achieved bacteriologic elimination.

 

Systemic tolerance to oral BANGSHIL ad­ministration were excellent. Renal function re­mained normal throughout the study in all pa­tients of both groups, as reflected by serial measurement of Serum creatinine concentra­tion. Further more post therapy urinalysis didn't reveal presence of cast in any patient.

 

DISCUSSION:

Increasing drug resistance to commonly used antimicrobials, increasing cost of drugs, toxic side effects of the broad specturm antimic­robial agent, discouraging pattern of antibiotic sensitivity to causative pathogen and inability to afford due to poverty are the main problem in tJTI management.

 

Considering the fact BANGSHIL an Indian medicine has been evaluated in management of UTI with strict watch on safety margin. Study reveals 100% patients of urinary tract infection irrespective of their status i.e. either of Group A (Patients of UTI without any treatment ) or Group B (Patients of UTI who had taken treat­ment without any clinical cure) shows clinical and bacteriological cure by 14th day of the therapy.

 

No patients revealed any recurrence or re­lapse of UTI in post therapy follow up. No pa­tient shows any persistance of infection in either of the group.

 

This observation also reveals that BANGSHIL has certain sensitivity to the causa­tive pathogens which also simulates with-the study of R. Anjaneyalu et. al.

 

REFERENCES:

1. Shanker. A., Ayurvedic medicine in man­agement of urinary tract infection. Vo. XXVIII, No. 11/86, H NIMA.

2. Wahab, M.A., Tejwani, B.B., Pathak, L. P., Bangshil. in urinary tract infection, Ind. Pract„ 15:3,119, March 1972.

3, 8ajapi, C.M., Common resistant & recurrent non specific genito urinary tract infection treated with an Ayurvedic drug, Ind.. Pract. 19:12, 813/1967.

4. Lohokare S.K. Bangshil in treatment of UTI in cases of traumatic paraplegia and multi­ple fracture, presented at Maharashtra - State Medical Conf. at Baramati, 1975.

5. K. K. Shah, Bangshil in UTI as an adjuvant to surgical treatment, Vol. XVII. No. 3, March 1977, Medicine & Surgery.

6. R. Anjaneyulu, Vartek M.M. et al, Bangshil in treatment of UTI, Current Medical Prac­tice, 18:2, 74-76/Feb/1974.

 

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