Cystitis, Interstitial Cystitis, Protocols

Treatments for Biofilm Infections

In my last post I’ve looked at biofilm infections and why they could be at the root of bladder problems. In this post I’m going to look at potential treatments for biofilm infections.

If you haven’t read my last post yet it might be a good idea to read it now. It explains what biofilms are.

Biofilms have been recognized to play a role in many infections, yet orthodox treatment options are still limited and research is ongoing.

Treating biofilms is difficult because of the limited ability of antibiotic agents to actually get to the bacteria. Natural antibiotics are no exception.




How is a biofilm infection diagnosed?

For patients with a urinary catheter a biofilm infection is suspected if they have recurrent urinary tract infections with the same pathogen (often Candida or Enterococcus species) [1].

For everyone else it is not as easy to get diagnosed.

Different methods have been used in studies to look for biofilm infections:

  • Tissue biopsy together with microbial cultivation in a lab is one option but newer techniques of microbiology are probably more accurate. These include gene sequencing or fluorescence in situ hybridization (FISH) [1].
  • Bacteria can be cultured from urine samples and can be checked for their ability to produce biofilms in a petri dish [2]. However, this method would not necessarily confirm a biofilm infection in the body.
  • High-resolution microscopy could be used to look for biofilms and pods in the bladder.

Unfortunately I could not locate any private labs in the UK that test for biofilms in the bladder.

There are two doctors in London that test and treat for biofilm infections: Professor James Malone-Lee and Dr Sohier Elneil (trained by Malone-Lee). Please get in touch with the COB foundation (www.cobfoundation.org) for an information pack.

Given the limited choice of testing options and available doctors that specialize in biofilm infections it may be difficult and time consuming to get a diagnosis/treatment.

Luckily there are safe and natural options that can help prevent and fight biofilm infections.

Natural Prevention of Biofilm Formation

There are several supplements and foods that can prevent bacteria from forming biofilms in the first place. This can be achieved by disrupting bacterial communication (aka quorum-sensing) or by preventing bacteria from sticking to the bladder wall.

Zinc: Has been show to inhibit biofilm formation of several pathogenic bacteria, including E. Coli and Klebsiella [3, 4]. Zinc is commonly available as a supplement and safe to use.

Probiotics: Several probiotic strains of E.Coli have been shown to be able to outcompete pathogenic E.coli during biofilm formation [2]. The most promising strain is E. coli strain Nissle 1917 [5], which is sold in Germany under the brand-name Mutaflor.

Lactoferrin: Is a protein naturally found in our immune system. It can bind to free iron in the body. Iron is essential for bacterial growth and can feed pathogens. Bacteria need iron to form biofilms. Lactoferrin has been shown to have great potential against biofilm formation [6, 7, 8]

Ginger extract: Has antimicrobial properties and has been shown to inhibit biofilm formation [9].

Cranberry: The anti-oxidant compounds found in cranberry called proanthocyanidins (PACs) have been found to have an inhibitory effect on the adhesion of E. coli on the bladder and urethral lining, thereby reducing their ability to form biofilms [10].

 

Natural Biofilm Disruptors

Once a biofilm has formed it is hard to get rid of. The most promising strategy is to disrupt the biofilm in order to ‘expose’ the bacteria an then to use antimicrobials to kill the bacteria.

Acetic Acid (found in Apple Cider Vinegar): Has been shown to be able to disrupt even mature biofilms and also has antimicrobial activity [11]. Use raw ACV and dilute with water (probably best taken on an empty stomach).

Bacteriophages: Are viruses that infect bacteria. They are the ‘natural predators’ of bacteria and are able to break down biofilms and kill even antibiotic resistant bacteria [1, 2]. Bacteriophage therapy is currently available at the Phage Therapy Center in the country of Georgia (www.phagetherapycenter.com).

Chitosan: Has antimicrobial properties and can damage microbial biofilms [12].

Garlic extract: May alter the architecture of biofilms, making the bacteria more susceptible to antimicrobials [2]. Garlic also has antimicrobial properties.

N-Acetylcysteine (NAC): Contains both sulphur and the amino acid cysteine. It is a precursor to the body’s master-antioxidant glutathione. Has been shown to disrupt biofilms [13].

Honey: Has antimicrobial properties and may disrupt biofilms. Manuka honey may be particularly useful [14].

Caprylic Acid: Derived from coconut oil. Has antimicrobial properties. Has also been shown to eradicate biofilms in a petri dish [15].

Proteolytic enzymes: They can disrupt the biofilm matrix by digesting some of the proteins that maintain it. Useful proteolytic enzymes include Trypsin, Serratiopeptidase and Nattokinase [16, 17, 18]. There are also specialist biofilm disruptor blends (Interfase Plus from Klaire Labs and Biofilm Defense from Kirkman). These enzymes need to be taken on an empty stomach in order to disrupt biofilms (otherwise they will just digest proteins in food). NB. People with bleeding disorders or those on blood-thinning medication should not take proteolytic enzymes.

 

Herbs that may disrupt biofilms

When using herbs we always need to remember that although natural, they can be powerful and may have adverse effects or could be contraindicated with certain medications. It is always best to work with a qualified herbalist.

  • Curcumin
  • Berberine
  • Cinnamon
  • Black seed oil
  • Boswellia
  • Vanilla
  • Gingko
  • Oregano oil
  • Quercetin
  • John’s Wort
  • Neem
  • Mangosteen
  • Alfalfa

Natural Antimicrobials

Once we have disrupted the biofilm the bacteria need to be killed with antimicrobials. Conventional treatment would use antibiotics in conjunction with biofilm disruptors. Natural antimicrobials can also be very effective. Some of the aforementioned biofilm disruptors also have antimicrobial properties. These include:

  • Garlic (Allicin)
  • Berberine
  • Manuka Honey
  • Acetic Acid
  • Caprylic Acid
  • Oregano Oil
  • Neem
  • Chitosan
  • Lactoferrin

Other options could be:

  • Olive Leaf Extract
  • Uva Ursi
  • Plant Tannins

 

If you think you may have a biofilm infection you may find relief with this natural approach.

Let me know how you got on in the comments!



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Treatments For Biofilm Infections | Bladder-Help.com

Sources

  1. Wu, Hong et al Strategies for combating bacterial biofilm infections International Journal of Oral Science(2015) [7, 1–7] available at: http://www.nature.com/ijos/journal/v7/n1/full/ijos201465a.html
  2. Soto, Sara M. Importance of Biofilms in Urinary Tract Infections: New Therapeutic Approaches Advances in Biology 2014 [vol. 2014, Article ID 543974, 13 pages] available at: https://www.hindawi.com/journals/ab/2014/543974/cta/
  3. Hancock, Victoria et al Abolition of Biofilm Formation in Urinary Tract Escherichia coliand Klebsiella Isolates by Metal Interference through Competition for Fur Environ. Microbiol. June 2010 [vol. 76 no. 12 3836-3841] available at: http://aem.asm.org/content/76/12/3836.full
  4. Wu, C. et al Zinc as an agent for the prevention of biofilm formation by pathogenic bacteria. Appl. Microbiology 2013 [115(1):30-40] available at: https://www.ncbi.nlm.nih.gov/pubmed/23509865
  5. Hancock, Viktoria et al Probiotic Escherichia coli strain Nissle 1917 outcompetes intestinal pathogens during biofilm formation Med. Microbiol., April 2010 [59: 392-399] available at: http://jmm.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.008672-0
  6. Ammons, MC et al Mini-review: Lactoferrin: a bioinspired, anti-biofilm therapeutic. 2013 [29(4):443-55.] available at: https://www.ncbi.nlm.nih.gov/pubmed/23574002
  7. Singh, PK et al A component of innate immunity prevents bacterial biofilm development. 2002 May 30 [417(6888):552-5.] available at: https://www.ncbi.nlm.nih.gov/pubmed/12037568?dopt=Abstract
  8. Orsi, N. The antimicrobial activity of lactoferrin: current status and perspectives. 2004 Jun [17(3):189-96.] available at: https://www.ncbi.nlm.nih.gov/pubmed/15222464Kim, Han-Shin et al.
  9. Ginger Extract Inhibits Biofilm Formation byPseudomonas aeruginosa PA14 PLOS one 2013 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0076106
  10. Howell, AB. Bioactive compounds in cranberries and their role in prevention of urinary tract infections. Mol Nutr Food Res. 2007 Jun [51(6):732-7.]
  11. Bjarnsholt, Thomas et al Antibiofilm Properties of Acetic Acid Adv Wound Care 2015 [4 (7): 363-372] available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486441/
  12. Zhang, Amin et al Chitosan Coupling Makes Microbial Biofilms Susceptible to Antibiotics Scientific Reports 3 2013, available at: http://www.nature.com/articles/srep03364
  13. Dinicola, S. et al N-acetylcysteine as powerful molecule to destroy bacterial biofilms. A systematic review. Eur Rev Med Pharmacol Sci. 2014 Oct [18(19):2942-8] available at: https://www.ncbi.nlm.nih.gov/pubmed/25339490
  14. Lu J, Turnbull L, Burke CM, et al. Manuka-type honeys can eradicate biofilms produced byStaphylococcus aureus strains with different biofilm-forming abilities. Wiles S, ed. PeerJ. 2014 [2:e326.] available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970805/
  15. Rosenblatt, J. Caprylic acid and glyceryl trinitrate combination for eradication of biofilm. Antimicrob Agents Chemother.2015 Mar [59(3):1786-8.] available at: https://www.ncbi.nlm.nih.gov/pubmed/25534725
  16. Chaignon P. et al. Susceptibility of staphylococcal biofilms to enzymatic treatments depends on their chemical composition. Appl Microbiol Biotechnol.2007 May [75(1):125-32] available at: https://www.ncbi.nlm.nih.gov/pubmed/17221196
  17. Mecikoglu, M. et al The effect of proteolytic enzyme serratiopeptidase in the treatment of experimental implant-related infection. J Bone Joint Surg Am.2006 Jun [88(6):1208-14.] available at: https://www.ncbi.nlm.nih.gov/pubmed/16757752
  18. Zapotokzna, M. et al An Essential Role for Coagulase in Staphylococcus aureus Biofilm Development Reveals New Therapeutic Possibilities for Device-Related Infections. J Infect Dis.2015 Dec 15 [212(12):1883-93.] available at: https://www.ncbi.nlm.nih.gov/pubmed/26044292

Soto, M. et al Implication of biofilm formation in the persistence of urinary tract infection caused by uropathogenic Escherichia coli CMI 2006 [12 (10): 1034-1036] available at: http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)62037-1/abstract

Challem, Jack NAC the Super Nutrient betternutrition 2014 http://www.betternutrition.com/nac-super-nutrient/

Kresser, Chris Treat and Prevent UTIs without drugs Chris Kresser 2012 https://chriskresser.com/treat-and-prevent-utis-without-drugs/

Cohen, Joe 54 Science-Backed Ways to Inhibit Biofilms Naturally Selfhacked 2016 https://selfhacked.com/2016/03/01/44-science-backed-ways-to-inhibit-biofilms-naturally-with-references/#How_to_Inhibit_Biofilms_Natural_Biofilm_Disruptors

Håversen, Liliana A. Human Lactoferrin and Peptides Derived from a Surface-Exposed Helical Region Reduce Experimental Escherichia coli Urinary Tract Infection in Mice Infect Immun. 2000 Oct [68(10): 5816–5823.]

Hudson, Tori N.D. Bladder Infections in Women – A Natural Approach Dec 13th, 2008 http://drtorihudson.com/prevention/bladder-infections-in-women-a-natural-approach/

 

 

24 Comments

  • Reply

    Valerie

    November 6, 2016

    Thank you for this, my daughter suffers from interstitial cystitis. I will pass this along to her! =)

    • Reply

      Layla

      November 7, 2016

      Thank you, Valerie! I hope it’ll be of help to her. Also good luck with your own journey!

  • Reply

    Debbie

    December 19, 2016

    Hi Valerie,

    Thank you for all of this information. Have you tried any of these with out bladder being so sensitive it’s difficult to know which to try first.

    • Reply

      Layla

      December 22, 2016

      Hi Debbie, Personally I would probably start with Lactoferrin and maybe Curcumin as these may both disrupt biofilms as well as having anti-inflammatory properties (potentially help soothe the bladder) and also anti-microbial properties without harming the ‘good’ bacteria.

  • Reply

    Alex

    December 31, 2016

    Do you know how dr Malone lee treats the biofilm? My understanding is that most biofilm disruptors are designed for the gut and do not reach the bladder, hence why “IC” is so difficult to treat. Any ideas?

    • Reply

      Layla

      January 1, 2017

      Hi Alex,
      Sorry, I don’t know about Dr Malone as I haven’t gone through the treatment myself. The COB foundation would know more about it. From looking at the research, the common approach seems to be what I have listed in this article. I have not come across anything designed specifically for the bladder and unfortunately research into IC is still limited. Some of the natural compounds should be able to get into the bladder as well though, as quite a few of them have also been indicated for UTIs, plus they have been shown to help disrupt biofilm formation.

  • Reply

    IMB

    January 22, 2017

    I am wondering how I would know whether or not my biofilm has been disrupted. Also, is there a protocol (how much and how often?) for any of the herbs, enzymes, etc. on your lists? Thanks.

  • Reply

    Layla

    January 23, 2017

    I don’t think there is any way of finding out for sure unfortunately, as there is no widely available testing (that I know of). But typically, if you are using biofilm disruptors and antibiotics, you may see an exacerbation of symptoms (aka the healing crisis, where bacteria die and secrete toxins that can cause symptoms) followed by an improvement. Dosage would very much depend on what you are using and duration could be anything from 1-3 months, depending on your individual case.

  • Reply

    A Gent

    November 22, 2017

    Hi Layla, that is a brilliant article about bio films. Really informative. I have been struggling with Bladder problems for two years now. My Dr. has labelled my condition OAB and had never heard of IC when I mentioned it. Treatment with Tolterodine and Betmiga did not help me at all, in fact some of my symptoms were worse.
    I am now using Diet and Supplements with a little success. Uva Ursi tincture, oil of Oregano(ugh!) and a mixture of Bicarbonate of Soda and D Mannose are the most helpful things I have found. I also take VSL 3 Probiotics and Quercetin. I followed Amy Myers’ Immune System Diet for a month and now stick mostly to her food recommendations, although the GAPS DIET is very similar. I also use organic Turmeric, Garlic and Ginger in cooking/ drinks every day, and do daily pelvic floor and yoga exercises.
    A lot of my help came from Bladder Health UK which is a wonderful support. I hope some of these ideas may help others. Adrianna

  • Reply

    Jacqueline

    December 9, 2017

    For the last 6 months I have had a cycle of UTI’s and thrush. I have been prescribed 4 different antibiotics,which of course starts the thrush again. I have been given oestrgen cream to strengthen the vaginal and Urinary tract ‘s health, but I still have at least 3 days a week when I can feel thrush starting up again, and the physical symptoms of the UTI still persist-even though a urine test shows no bacteria[ It was an e-coli strain that was identified. Ig, small quantities of urine, and spasms in the urethra.[ locally applied Hydrogen peroxide at 3% keeps the thrish in check].
    This week I had a cysoscopy, and an area of Cystisis cystica was found, a long half moon shaped area in the Trigone area of the bladder.
    I asked the Doctor what I could do the treat this, and he said just drink 3 litres of water a day.
    I can find nothing about this condition on lne, except that it is rare. Does this mean a biofilm is still trapping bacteria. Would this be a condition that needs a long course of low dose antibiotics?
    Can these ‘cycts’ be cured-or is this a chronic condition that is giving me the UTI symptoms still?
    If you know how to deal with CC I would be so grateful.
    Would a bladder wash out be effective?

    • Reply

      Layla

      December 9, 2017

      Hi Jacqueline, I have to say that I didn’t know much about cystitis cystica and personally have no experience with it. I’ve had a little look through the research for you – a lot of it is old. One thing I picked out is that it seems to be some change to the mucus lining in the bladder, potential reasons for which can be chronic infections (http://hrcak.srce.hr/122239, http://www.jurology.com/article/S0022-5347(17)39950-0/abstract). One old study mentioned the potential of parasites. To me it would make sense that biofilm infections or even intracellular bacteria (http://bladder-help.com/intracellular-bacteria-hidden-cause-bladder-problems/) could play a role and therefore I would deal with it in the same way as I would with chronic infections – boost the immune system, remove pathogens (including biofilms), balance the micro flora etc.
      Antibiotics can be a problem as they also kill good bacteria, but no yeasts (hence the thrush). If it’s available to you, I’d get proper metagenomic testing done, maybe also check for fungi and parasites. For chronic bacterial infections new research suggests that high dose antibiotic therapy, long enough to eradicate all pathogens may be best – I’d look into professor Malone-Lee’s research on this.
      I don’t know anything about a bladder wash-out but I could imagine it to be disruptive to micro flora – i can’t give you any advice on this though, sorry!

      • Reply

        Jacqueline

        December 10, 2017

        Thank you so much.
        Do you have a regime to break up the biofilm?
        eg:
        ACV twice a day
        D-mannose 4 times a day etc?
        How will I know if the biofilm has been broken, and at that stage do I need antibiotics to kill off the newly exposed bacteria. I know mine are e-coli.

      • Reply

        Jacqueline

        December 10, 2017

        Hi Layla,
        Have you come across any treatments that use Peptide 1018 – I see there are a lot of studies that show it breaks down biofilms, but can’t see if it’s available as a treatment to buy?
        I also came across this: Kirkman Labs, Biofilm Defense, 60 Capsules. Do you have any comments about them?

        Many thanks
        Jacqueline

        • Reply

          Layla

          December 10, 2017

          Hi Jacqueline,
          Peptide 1018 so far seems to only have been used in research trials and is not commercially available yet (and if it was it would probably be sold as a medicine). Biofilm Defense and also InterFase plus are enzyme based supplements that need to be taken on an empty stomach. So a regime could look like this: Biofilm Defense (or Interfase) an hour before breakfast and dinner, plus maybe a beneficial bacteria supplement. With the meals Lauricidin (antimicrobial). Herbs etc from the list in my article for cooking, ACV as a condiment, raw Manuka honey as a sweetener (in moderation).

          • Jacqueline

            December 15, 2017

            Two expert Urologists seem to use 2 different ways to use antibiotics for chronic UTI’s. One promotes high dose long term and one low dose long term use. As long term use normally means awful thrush, what are we to do?

            I have for the last 3 days used ACV, followed by D-Mannose 3 times a day, and I think I am beginning to see a slight improvement in the ‘spasm’ and pain caused by chronic UTI’s.

          • Layla

            December 15, 2017

            The leading UK consultant on chronic UTIs promotes high dose antibiotics, long enough to kill bacteria coming out from shedding cells. I have no personal experience with either approach.
            I’m glad you’re seeing a difference though!

  • Reply

    Sam

    March 18, 2018

    Hi, Thank you for the above – I have some questions:

    1) Which Lactoferrin product would you recommend?
    2) Is there a chance that biofilm disruptor products could cause an infection as you are killing off the bacteria? If so, would you recommend taking D Mannose with the biofilm disruptor and at what dose?
    3) How long should you take the biofilm disruptor product for and at what dose?
    4) Which product would you recommend – Interfase Plus from Klaire Labs or Biofilm Defense from Kirkman?

    Thank you

    • Reply

      Layla

      March 21, 2018

      Hi Sam!
      1) I don’t really like to endorse specific brands – I would look for one by a reputable supplement manufacturer that is available to you where you are, look for one without unnecessary additives and a high dosage per capsule.
      2) Yes, it may be that disrupting the biofilms ‘releases’ some of the bacteria alive (or even the ‘die off’ may lead to some symptoms). D-Mannose is only good for E Coli as it prevents them from re-attaching to the bladder wall. You could try a natural antimicrobial such as Lauricidin.
      3) It depends on severity – 1 to 3 months. A common dosage would be 1-3 capsules daily on an empty stomach (working up slowly).
      4) They are both similar, I’d see which one is available to you.

  • Reply

    George

    June 26, 2018

    Hi, I have a chronic enterococcus faecalis infection in my bladder and prostate from a catheter. It has caused all sorts of problems including pain and non-stop urgency. At one point I was told that I had interstitial cystitis and went through several bladder installations to no effect. At this point I am convinced that the inflamed bladder vessels that were found in my bladder were actually biofilm. None of the antibiotics I have taken over the past two years have done anything and at this point I am going to see an infectious diseases doctor. I also ordered bladder defense to try and get rid of the biofilm. Also is there anything in medicine that can treat urinary biofilm? I am at a loss because for two years I have had the urge to urinate all day long and it has completely drained me physically and mentally. Any advice would be greatly appreciated. Thank you.

    • Reply

      Layla

      June 26, 2018

      Hi George, some people have had success using Interfase together with antibiotics over a longer period of time. Interfase or similar products are designed to ‘digest’ biofilms, exposing the bacteria so that they can be killed by antibiotics.

  • Reply

    Candice SanPietro

    July 3, 2018

    Unfortunately I too have struggled for two years with bladder biofilm and recurrent ecoli infections. I alternate trimethoprim for a few months to methane hib which is a formaldehyde med. I’ve heard bladder washes can be helpful but again no definitive and no specialist rec. I read suggestions but no solid regime with research back up. I’ve tried it all…enzymes, zinc, Lactoferrin, nac, mannose and on and on. Isn’t there anyone who can treat this or is it a chronic condition with no hope in sight? ??? ….Which by the way has been my experience thus far. There’s got to be something other then throwing everything at this only to then find out the dosage wasn’t enough or the intervention ended up making the bacteria stronger in the long run. I’ve had kidney stone removal, laser on the area of colonization only to go back 6 months later to find the infection dispersed thruout the bladder and got worse. Very expensive and frustrating to follow suggestions where the directions are limited to ‘may help’…..

    • Reply

      Layla

      July 3, 2018

      Hi Candice, how do you know it is definitely biofilms? In my opinion it is sometimes not enough to just treat the one symptom in the bladder, when I work with people I look at the rest of the body (especially the gut) to address any underlying issues. If the immune system isn’t strong and healthy, there could be a chance that it would be hard to overcome such issues. So I personally would look at supporting the immune system, the gut etc.
      One-size doesn’t fit all as well, so what works for one may not help another unfortunately.

  • Reply

    Sara

    July 15, 2018

    Thank you for this most interesting article. The comments are helpful too. What have you heard about xylitol for disrupting biofilms?

    • Reply

      Layla

      July 17, 2018

      Hi, I know that xylitol is used in oral care to disrupt biofilms (plaque). Internally I’m not sure, it can certainly feed some bacteria in the gut and cause diarrhoea in larger amounts. Plus non-nutritive sweeteners can be an issue for people with autoimmunity.

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