Aims: Finding effective prophylaxis for recurrent Urinary Tract Infections is high priority due to their high prevalence causing them to be the most abundant infection which require antibiotics. (Lichtinger et al, 2020). Uromune is a sublingual vaccine containing equal quantities of Escherichia Coli, Klebsiella Pneumoniae, Proteus Vulgaris and Enterococcus Faecalis whole inactivated bacteria which aims to stimulate the mucosa and prevent further infection. (Nickel et al, 2020). This systematic review was conducted to determine the efficacy and safety of the bacterial sublingual vaccine Uromune in preventing recurrent Urinary Tract Infections (UTIs). To understand Uromune’s potential role in minimising antibiotic resistance via reducing the consumption of antibiotic prophylaxis.
Methods: Five online databases were searched for publications which investigated the effectiveness of the sublingual vaccine Uromune, a total of 135 search results were analysed. Publications which included follow-up at least 12 months post vaccine administration were included to ensure the longitudinal efficacy of the vaccine. A total of four studies were included in the primary analysis with an addition three studies included for a secondary review.
Results: The mean percentage of participants who were UTI free at 12-months post vaccine administration was 78.3% meaning 484 participants who previously suffered from recurrent UTIs did not experience a single UTI in 12-months. A mean percentage of 95.68% of participants reported no side effect, adverse reactions or allergic reactions whilst completing the 3-month course of Uromune. In comparison to antibiotic prophylaxis of sulfamethoxazole/trimethoprim or Nitrofurantoin for 6 months, Uromune increases the UTI-free rate by a mean 66% between 9-15 months.
Conclusion: This research challenges current NICE guidance by providing a highly efficacious alternative prophylaxis with minimal side effects which is more effective that the current NICE recommendations. This research concluded the efficacy of Uromune decreased progressively over time raising the question of whether it is suitable to readminister the vaccine after a certain period. Future research should address the safety, costs and potential benefits of re-administration in a randomised, double-blind placebo-controlled trial to develop more accurate conclusions about the sublingual vaccine Uromune.
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