Canephron is endorsed and recommended as a first line, antibiotic sparing treatment in the European Association of Urology (EAU) guidelines, and this guideline has been endorsed and adopted by the Urology Society of Australia and New Zealand (USANZ).
Canephron Urinary Tract Support is for the symptomatic relief of medically diagnosed, localised[1] urinary tract infections (UTIs), comparable with antibiotic treatment[2], without the negative consequences[3]. Canephron’s anti-inflammatory[4], analgesic[5], anti-spasmodic[6] and bacterial flushing[7] effects, relieve all the major symptoms of localised UTIs in a comparable manner to that of an antibiotic[8].
Treatment without antibiotics
Antibiotics are an important medication to help bacterial infections. However, there are instances where antibiotics are not suitable for patients, depending on a variety of factors. Canephron is clinically tested and provides an option where antibiotics are unsuitable for the patient. By sparing the use of antibiotics while delivering comparable and immediate outcomes, Canephron also supports antibiotic stewardship and allows antibiotic use to be reserved for treatment situations where they are truly required. Additionally, the delicate equilibrium of human gut microbiota that is damaged using antibiotics is not upset when Canephron is used[9].
Comparability of treatment to that with antibiotics
In a randomised, controlled, Phase III non-inferiority clinical trial with 659 participants it was demonstrated in both arms that 83.5% (Canephron) and 89.8% (fosfomycin) required no additional antibiotics in their treatment of acute lower uncomplicated urinary tract infections up to day 38 following treatment[2].
As such, based on a 15% non-inferiority margin Canephron was non-inferior to fosfomycin in the treatment of localised UTIs[2]. The study also demonstrated that Canephron reduced the symptoms (using an ACSS typical domain) of cystitis at the same rate as fosfomycin[2].
This study compared Canephron to fosfomycin because fosfomycin is the recommended first line treatment for UTIs by EAU (and USANZ) due to its efficacy in E.Coli infections and low levels of resistance. Other antibiotic agents such as trimethoprim are recommended second line and have high recorded resistance levels (up to 27%)[12] and as such are unlikely to obtain the same degree of result as fosfomycin and Canephron. Bionorica continues to run comparative studies and has a head-to-head study on-going with nitrofurantoin (which is also a recommended first line antibiotic for UTIs).
Negative impacts of the use of antibiotics in the treatment of UTIs (and other minor infections)
The increasing number of antibiotic resistant infections appearing in the Australian community and acquired from international travel represent a looming health issue[13]. A CSIRO report published in 2022 found that high prevalence of UTIs make them a major contributor to antibiotic use in Australia, and in a study conducted along with QUT and University of Queensland[14] with data from 21,268 patients, showed that those patients who contracted drug resistant P. aeruginosa UTIs in the community were more than twice as likely to die from the infection in hospital than those without resistant bacteria.
As such, the need for treatments which are antibiotic sparing are clear and is in part why the recently publish EAU (and USANZ) guidelines highlight the need to offer patients a non-antibiotic option for UTI treatment. In addition to the increasing risks related to overuse of antibiotics, there are additional health impacts from antibiotic use related to their impact on the microbiome. Research has observed an acute decrease in species richness and culturable bacteria in the microbiome after antibiotics, with most healthy adult microbiomes returning to pre treatment species richness after 2 months, but with an altered taxonomy, resistome, and metabolic output, as well as an increased antibiotic resistance burden. In fact, immediately after antibiotic usage, changes in the microbiome can leave patients more susceptible to re-infection or infection from opportunistic pathogens[15]. Studies comparing the microbiome in mouse models after treatment with Canephron (CLR) verses treatment with either fosfomycin or nitrofurantoin highlight the significant shifts in the microbiome caused by antibiotic treatment[16].
Less likely need for antibiotics following treatment with Canephron
The recurrence rates of both sporadic and frequent recurrence of localised UTIs following treatment with Canephron are significantly better than treatment with an antibiotic[17].
Positive outcomes for recurrence when an antibiotic must be used
Even when it is determined based on clinical evaluation that an antibiotic is the best course of treatment, co-administration with Canephron has shown significant improvements in recurrence than the use of antibiotics alone[18]. In a study comparing the use of Canephron in combination with ofloxacin compared to ofloxacin alone, there were significantly lower levels of recurrence with the combination treatment (at 6 months, 50% lower, and at 12 months 55% lower).
