| Sažetak | U suvremenoj medicini, infekcije mokraćnog sustava i dalje predstavljaju iznimno velik ekonomski i socijalni teret na zdravstveni sustav, a nerazumnim propisivanjem antibiotika pridonosi se povećanju antibiotske rezistencije kao i smanjenju njihove učinkovitosti, što također predstavlja jedan od najvećih problema suvremene medicine. Uzimajući u obzir sve te podatke, možemo zaključiti da budućnost liječenja i profilakse infekcija mokraćnog sustava kod osoba ženskog spola, koje od istih i puno češće obolijevaju, moramo potražiti u učinkovitim alternativnim metodama, odnosno zamjenama za antibiotike. Nadalje, u smjernicama Europskog urološkog društva, najmanje je riječi i dokaza o učinku D-manoze što je ujedno i obraloženje odabira navedene teme. Pretragom literaturnih podataka i studija o učinkovitosti D-manoze kao monoterapije u liječenju i prevenciji rekurentnih IMS kod žena reproduktivne dobi, može se zaključiti da je D-manoza učinkovita kako u liječenju, tako i u prevenciji od ponovnih epizoda infekcija mokraćnog sustava, odnosno nekompliciranih cistitisa. Obzirom da je, za daljnje zaključke i potvrde s visokim razinama dokaza, potrebno provesti više preciznijih studija s većim brojem ispitanica, D-manoza se još uvijek vodi kao dodatak prehrani i za sada nema registriranih lijekova na bazi D-manoze, što je upitno sa strane kakvoće same tvari. Za temu ovog diplomskog rada pretražene su baze WoSCC i Scopus prema prilagođenim PRISMA smjernicama te su nakon probira studija koje obuhvaćaju temu ovog rada, studije opisane kroz PICO kriterije. Prema radnoj grupi GRADE, sve probrane studije korištene u evaluaciji dokaza D-manoze za ciljanu skupinu ispitanica isključivo su mala randomizirana ispitivanja s nižom metodološkom kvalitetom, stoga bi se razina dokaza D-manoze svrstala u skupinu II popisanih razina dokaza radne skupine GRADE. Zaključno, pacijente je potrebno educirati o upotrebi učinkovitih alternativnih metoda liječenja kojima bi se smanjila nerazumna potrošnja antibiotika i povećala svijest pacijenata o problemu antibiotske rezistencije. Upravo u tome svemu najveću ulogu može imati ljekarnik kao najdostupniji zdravstveni djelatnik koji bi na temelju znanstveno točnih i utvrđenih podataka, educirao građanke i građane o pravilnoj upotrebi terapije i razumnom pristupu liječenju. |
| Sažetak (engleski) | In modern medicine, urinary tract infections (UTIs) continue to represent an extremely large economic and social burden on the health system, and the unreasonable prescription of antibiotics contributes to the increase of antibiotic resistance as well as to the reduction of their effectiveness, which is also one of the biggest problems of modern medicine. Considering all these data, we can conclude that the future of treatment and prophylaxis of urinary tract infections in women, who suffer from them much more often, must be found in effective alternative methods, i.e., substitutes for antibiotics. Furthermore, in the guidelines of the European Urological Society, there are only few words or evidence about the effect of D-mannose, which is also the main reason of choosing this topic. By searching literature data and studies on the effectiveness of D-mannose as monotherapy in the treatment and prevention of recurrent UTIs in women of reproductive age, it can be concluded that D-mannose is effective both in the treatment and in the prevention of repeated episodes of urinary tract infections, i.e., uncomplicated cystitis. Considering that, for further conclusions and confirmations with high levels of evidence, it is necessary to conduct more precise studies with a larger number of subjects, D-mannose is still used as a dietary supplement and for now there are no registered medicines based on D-mannose, which presents the questionable side of the quality of the substance itself. For the topic of this thesis, the WoSCC and Scopus databases were searched according to the adjusted PRISMA guidelines, and after selecting the studies that cover the topic of this thesis, the studies were described using the PICO criteria. According to the GRADE working group, all the selected studies used in the evaluation of the evidence of D-mannose for the target group of subjects are exclusively small, randomized trials with lower methodological quality, therefore the level of evidence of D-mannose would be classified in group II of the listed levels of evidence of the GRADE working group. In conclusion, patients need to be educated about the use of effective alternative treatment methods that would reduce the unreasonable consumption of antibiotics and increase patients' awareness of the problem of antibiotic resistance. In solving all the mentioned problems, the greatest role can be played by the pharmacist as the most accessible healthcare worker who, based on scientifically accurate and established data, would educate citizens about the correct use of therapy and a reasonable approach to treatment. |
