Have you ever heard about boric acid? Suppositories of boric acid are often used to manage vaginal infections. But is it effective to prevent or treat urinary tract infections? We are going to discuss it in this article. We will also talk about the efficacy of other suppository medicine in UTI. Let’s start.
| Suppository | Effectivity against UTI | Route of administration | safety |
|---|---|---|---|
| Boric acid | Prevents recurrent UTIs by promoting vaginal health | Vaginal | Considered safe for vaginal use in patients with bacterial or fungal vaginosis |
| Paracetamol | Analgesic effect. alleviate fever and abdominal pain of UTI | Rectal | Generally safe. 125mg and 250 mg suppositories can be used for children |
| Tramadol | Analgesic effect. used for intense pain (prescription-only) | Rectal | Patients need doctor’s constant supervision when using any form of tramadol |
| Clindamycin and metronidazole | Used to treat vaginal infections and thus reduce the risk of UTIs. (prescription-only) | Vaginal | Safe if used as indicated by the doctor |
| Lactobacilli | Prevents the recurrence of UTI, especially among postmenopausal women. | Vaginal | Safe for use in UTI prevention |
| Consult a doctor before using any of these suppositories | WWW.TREATUT.COM |
What is boric acid?
Boric Acid is an odourless solid compound that is also known as orthoboric acid or boron oxide hydroxide. Chemically it is a weakly acidic hydrate of boric oxide. It has mild but broad antiseptic, antifungal, and antiviral properties.
Due to its antimicrobial properties, it is being used as a topical drug in alternative medicine for hundreds of years. It is well known for its use in the preservation of urine during transport to the clinical laboratory. Recently it is being used in modern medicine too for various purposes including vaginal candidiasis (fungal infection of the vagina).
Does boric acid have antimicrobial effects?
To understand the efficacy of boric acid in urinary tract infection, we need to discuss its antimicrobial effect first. Boric acid is not usually classified as an antibiotic, but it has some antimicrobial properties.
According to the mode of action, antibiotics are classified into two groups: bactericidal and bacteriostatic. There are some antibiotics (e.g. ciprofloxacin, Penicillin, etc) that directly kill the bacteria and are termed bacteriocidal. And the bacteriostatic group of antibiotics do not kill the bacteria directly but inhibit their growth (e.g. Tetracycline).
Boric acid has the latter kind of action against bacteria. The exact mechanism is unknown but it has a weak bacteriostatic effect against different organisms including Gardnerella vaginalis (which causes bacterial vaginosis). Due to this bacteriostatic effect, boric acid is used to preserve urine samples in the laboratory. It can prevent any change in the bacteriologic status of urine for 48 hours.
In many infections including bacterial vaginosis, biofilm is formed over the mucosal surface which protects the bacteria from the action of the immune system and antibiotics. This biofilm makes the complete cure difficult and often causes recurrence of the infection.
Bacterial vaginosis is the most common vaginal infection. Its prevalence varies from 10 to 65% and is higher in sexually transmitted disease (STD) clinics. Women with bacterial vaginosis are at increased risk for urinary tract infections. Many studies showed that boric acid can inhibit biofilm synthesis and help to achieve cure.
The use of boric acid is expected to prevent the extensive use of antibiotics that can lead to microbial resistance.
The role of boric acid in the inhibition of bacterial growth and biofilm synthesis is crucial here. Different studies show that it can be used in chronic infections like CSOM (a chronic infection of the middle ear), chronic wound infection, etc. However, the use of boric acid as a first-line therapy needs further research. Note these points, we will discuss them later concerning UTI.
The antifungal effect of boric acid is very significant, especially against Candida.
Candida is the most common cause of vaginal fungal infection. Usually, antifungal agents like Azoles (e.g. fluconazole, clotrimazole, etc) or nystatin is used to treat candidiasis. But there are different species of Candida. Candida albicansis the commonest one. Other species are collectively termed as non-C. albicans.
Infections by some of these strains are tough to eliminate and these antifungals often fail to achieve complete cure. Moreover, drug resistance is increasing day by day. Boric acid showed a promising effect in treating vaginal candidiasis. Although no direct comparative trials exist, boric acid may have improved activity against non-Candida albicans species.
Candida glabrata is the most common of the non-C. albicans species. Many isolates of C.glabrata are resistant to azole agents. Boric acid has been demonstrated to be active against C.glabrata isolates that are resistant to azoles although the data is limited.
Chronic fungal infection is difficult to cure. A study shows that the ineffectiveness of conventional antifungal agents is the main reason for chronic mycotic infections. In contrast, boric acid was effective in curing 98% of the patients who had previously failed to respond to the most commonly used antifungal agents and was clearly indicated as the treatment of choice for prophylaxis.
Boric acid is also effective against Saccharomyces cerevisiae. It may cause vaginitis and urinary tract infection in persons with a suppressed immune system.
Multiple cases were reported where Saccharomyces cerevisiae infection did not respond even after treatment with fluconazole, clotrimazole, intravenous amphotericin B, and flucytosine. But great responses were obtained with daily use of two 600mg suppositories of boric acid. And the infection didn’t recur after completing the prolonged maintenance therapy.
Boric acid is also found to be effective against viruses like herpes simplex, but the mechanism is unknown. And you know, herpes viruses can cause viral UTI in an immunocompromised host.
Is boric acid effective in UTI?
Now, the burning question is going to be answered. Hope you have read the previous paragraphs carefully.
We have discussed that boric acid has some antibacterial effects. So theoretically it should be effective in UTI to some extent. It could also be effective against fungal and viral urinary tract infections.
According to pharmacology, it is readily excreted in urine which is an essential criterion for a drug to be effective in UTI. But wait, that’s not everything. Boric acid is not approved for oral ingestion and may cause toxicity.
It is well absorbed from the gastrointestinal tract and reaches all organs of the body via the blood body fluid. Excessive boric acid intake may cause cell damage in different organs, especially the kidneys. So, you can’t take it orally to treat or prevent urinary tract infections.
But the rate of absorption into the blood from the skin or vagina is very low. So it can be used as a vaginal suppository or topically over skin safely. But there is no way to apply it safely within the bladder or urinary tract. The amount that is absorbed and excreted in urine after vaginal application, is not enough to cure UTI.
Boric acid suppositories ( and literally all suppositories) are not suitable to use via the urethra. And if you put it accidentally in your urethra, you may experience pain and burning micturition. So, practically you can’t use boric acid to treat urinary tract infections.
But, boric acid may help you to prevent recurrent UTI by promoting vaginal health. It prevents bacterial vaginosis and vaginal candidiasis as we have already discussed. You know bacterial vaginosis is a risk factor for recurrent urinary tract infection.
Persistent infection in the vagina and altered vaginal pH creates a favourable environment for bacteria to enter the urethra. Boric acid help to maintain normal vaginal pH, promote normal Lactobacillus growth. Thus boric acid helps to prevent recurring urinary tract infections indirectly.
How to use boric acid suppositories?
Boric acid is available as vaginal capsules and suppositories. The usual dose is 1 suppository before bedtime for 3 to 6 days. Talk to your doctor before taking it. The capsules and suppositories are only for vaginal use and may cause toxicity if ingested.
Do not use it if there is any local wound or ulceration in the vagina. And if you are pregnant, stay away from boric acid as it may harm your baby.
Wash your hand before taking the suppositories and insert them within the vagina using the applicator provided. To avoid early dislodgement of the suppository, use it just before going to bed. During treatment, avoid sexual intercourse.
What are the side effects of boric acid suppositories?
In normal doses, it is usually well-tolerated. Because systemic absorption of boric from the vagina is less than 6%. Side effects are usually mild and may include:
- watery discharge from the vagina
- redness
- burning sensation (don’t misinterpret it as cystitis)
- A gritty sensation in the vagina etc.
Boric acid may cause a mild burning sensation like cystitis. But don’t worry, boric acid doesn’t cause UTI. Usually, you will have to do nothing for these mild symptoms and you will get used to these.
However, if you develop severe side effects, or symptoms of allergy like hives, severe itching, swollen genitalia and lips, etc, or worsening of the previous symptoms immediately stop the drug and call your doctor.
Is there any other suppository medicine having efficacy in UTI?
Now we will discuss other suppositories having a role in urinary tract infection. Some drugs may help to reduce the symptoms of UTI. You must know about the rectal suppository of paracetamol which may be used to alleviate fever and abdominal pain.
Tramadol suppository (prescription-only drug) may also be used if you have intense pain in the lower abdomen.
Suppository forms of antibiotics could be a great innovation for children or debilitated patients who can’t take medicine orally. Some rectal suppositories of antibiotics were tested but abandoned due to local irritation and adverse events. So they are not used nowadays.
Clindamycin and metronidazole are available in vaginal suppository and capsule formulations. They are used to treat vaginal infections and thus reduce the risk of urinary tract infections. But these are not so effective against the bacteria responsible for UTI.
Another promising drug for UTI prevention is Lactobacilli suppositories. Multiple studies showed that vaginal lactobacilli suppository prevents the recurrence of UTI, especially among postmenopausal women.
Due to altered vaginal pH and loss of normal flora, postmenopausal women often suffer from recurrent UTI. Administration of Lactobacillus cispratus suppositories was found effective in preventing UTI.
Which one is the best boric acid suppository brand?
Well, this is a difficult question to answer. Because there are lots of boric acid brands with good reputations and reviews. AZO may be a good choice as a well-known medical-grade product.
Among other commercially available brands, Nutrablast and Intimate rose have good customer reviews. You can choose any of those according to local availability.
That’s all for now. Hope you have got some idea about the role of boric acid in urinary tract infection. If there any confusions or queries, feel free to contact us. Thanks for reading with patience.