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Herbal approaches to polymicrobial biofilms in persistent urinary tract infections: Bridging tradition, practice, and science
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Herbal approaches to polymicrobial biofilms in persistent urinary tract infections: Bridging tradition, practice, and science

Cathrina Geldard
Southern Cross University
Doctor of Philosophy (PhD), Southern Cross University
2026
DOI:
https://doi.org/10.25918/thesis.601
Appears in  Recent Southern Cross PhD Theses
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Abstract

Polymicrobial biofilms Urinary tract infections Herbal medicine Antimicrobial resistance
Background: Recurrent urinary tract infections (UTIs) are increasingly understood as biofilm-mediated, frequently polymicrobial syndromes characterised by cycles of antimicrobial exposure, microbial tolerance and diagnostic ambiguity. Herbal medicines are widely used for urinary health, yet real-world prescribing, traditional knowledge and preclinical research remain poorly aligned: most laboratory studies test non-traditional preparations or isolated constituents at supraphysiological concentrations against single-species or planktonic cultures, limiting clinical translation. Aim: To bridge traditional herbal knowledge, contemporary naturopathic practice and experimental biofilm science using a tradition-practice-science nexus to identify, prioritise and evaluate herbal medicines for persistent polymicrobial UTIs. Methods: A three-phase SCOPE-ASK-science sequence was employed. Phase 1 (SCOPE) conducted a scoping review of naturopathic texts, case reports and Balkan ethnobotanical surveys to map herbs, preparations and therapeutic rationales for urinary disorders. Phase 2 (ASK) surveyed international naturopaths and Western herbalists, documenting prescribing patterns, formulation types, dosing, clinical reasoning and perspectives on recurrence, antibiotic use and microbiome effects. Cross-analysis of SCOPE and ASK data generated a shortlist of 17 herbal candidates for laboratory testing. Phase 3 (Science) developed single-species and triple-species biofilm models incorporating Escherichia coli (ATCC 25922 and uropathogenic UTI89), Enterococcus faecalis and Candida albicans, and evaluated the 17 herbs as aqueous infusions at clinically informed concentrations, assessing biomass, viable counts and microbial community composition. Results: The scoping review identified 298 genera encompassing 468 species, with participating practitioners prescribing 22 species. In ATCC triple-species biofilms, low concentrations (32 µg/mL) of Achillea millefolium, Arctostaphylos uva ursi, Rosa canina, and Zea mays reduced E. coli and E. faecalis by 1.4–2.3 log10 but frequently promoted C. albicans growth or shifted bacterial dominance toward E. faecalis. Transitioning to uropathogenic E. coli UTI89-based communities markedly diminished or altered these effects, with A. millefolium remaining the only herb showing consistent activity. In UTI89 triple-species biofilms, Equisetum arvense (32 µg/mL) selectively suppressed C. albicans viability. In single-species biofilms, Hypericum perforatum (32 µg/mL) reduced E. coli (ATCC) and Chimaphila umbellata (2048 µg/mL) reduced E. faecalis viability. Non-monotonic concentration–response patterns, CFU–biomass decoupling, and bacterial–fungal trade offs were recurrent across treatments. Conclusion: UTI-focused herbal infusions functioned as low-concentration community modulators whose effects were shaped by strain background, polymicrobial context and concentration. These patterns are invisible to conventional single-species or planktonic approaches, reframing how herbal medicines for UTIs should be evaluated, dosed and integrated within biofilm-aware, AMR-conscious care. The SCOPE-ASK-science framework provides a reproducible, practice-grounded methodology for translating traditional and clinical herbal knowledge into clinically relevant preclinical research.

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