Vaginal bacterial infections
Q) I am a woman of 70 having a battle with an infection of Klebsiella for well over a year which has invaded the bladder/ urethra/vagina. Antibiotics, which it is sensitive to (I've had three types to date), appears to keep it quiescent for two weeks after the course has finished, and then it comes to the fore again. My personal hygiene is exemplary. My urologist and doctor can only offer antibiotics. Are there any effective alternatives?-S.D., Kent
A) Although not a household name, Klebsiella can be just as nasty as Escherichia coli, Clostridium difficile and MRSA (methicillin-resistant Staphylococcus aureus), the 'superbugs' plaguing hospitals with their multiple resistance to antibiotics. The chances are, you acquired your infection in hospital, possibly from a bladder catheter. The most common way to pick up Klebsiella is from an intensive care unit, which uses lots of tubes in lots of orifices.
Klebsiella is cleverer than most bacteria as its mucus covering makes it difficult to attack. This allows it to stand up to antibiotics and, hence, its resistance to most antibiotics. Klebsiella also has an amazing ability to transfer its own resistance to other totally different species of bacteria-something that other bacteria can also do (Infection, 1993; 21: 18-22).
The most commonly seen strain is K. pneumoniae, which affects the lungs, especially of alcoholics or those with existing lung disease. But K. pneumoniae can lodge itself elsewhere, as you have discovered. Despite its resistance to most antibiotics, the aminoglycosides and cephalosporins may still be effective.
However, the real problem with antibiotics, apart from resistance, is that they kill all bacteria-friend or foe. For this reason, many women taking antibiotics often develop a Candida infection in the vagina, because the friendly bacteria that normally keep this yeast at bay are killed off. This may be exacerbating your symptoms.
So, you're right to be looking for alternatives and, happily, there are a number of options, most of which apply to bacterial infections in general, and not just Klebsiella.
Of the herbal treatments, oregano (wild marjoram) has been shown to have specific "antimicrobial activity" against K. pneumoniae, although so far only in the lab (J Appl Microbiol, 1999; 86: 985-90).
A better bet may be tea tree oil (TTO), which has been used for about a century as an antiseptic. Latterly, it's come to the forefront again, following the embarrassing discovery that we've all been sold short on antibiotics. A recent review of the evidence has shown that TTO may be superior to antibiotics. It has at least four special advantages: it can kill viruses as well as bacteria; it doesn't trigger resistance; it works against antibiotic-resistant bacteria; and it has no side-effects apart from possible minor skin irritation. Again, however, the data are almost entirely laboratory-based (Clin Microbiol Rev, 2006; 19: 50-62). Nevertheless, a recent trial in a hospital setting found that TTO was 40-per-cent effective against MRSA (J Hosp Infect, 2004; 56: 283-6). TTO is available in liquid, pessary and cream formulations, and can work at concentrations as low as 1 per cent.
Another option is cranberry juice. This popular remedy for urinary tract infections has received the cold shoulder from the medical establishment, but it does work. One authoritative study found that cranberry juice can be diluted over 30 times, and still retain its effectiveness (JAMA, 2000; 283: 1691). Originally, its mode of action was thought to be simply a change of acidity, but it's now known to be much more sophisticated than that. Cranberries are naturally rich in a group of tannins called pro-anthocyanidins, which can change the shape of bacteria, and also reduce the stickiness of cell membranes. The upshot is that bacteria find it difficult to attach themselves to the body and, so, are flushed away by the usual bodily secretions.
Stronger still than cranberries is d-mannose. Derived from sugar, it has roughly the same mode of action as cranberries, but is claimed to be at least 10 times more powerful. A 4-per-cent solution has proved to be almost 100-per-cent effective in getting rid of K. pneumoniae (J Clin Microbiol, 1997; 35: 2370-4).
An important extra is to boost your immune system, as that will help you fight off the infection naturally. To do this, try taking Echinacea and vitamin C.
Finally, consider using probiotics to help normalize your intestinal bacteria (see WDDTY vol 17 no 10). At the very least, this will repair the damage done to your gut flora by all those antibiotics you've been taking.