Treatment Of Cystitis Research Articles

Inappropriate Empirical Treatment of Uncomplicated Cystitis in Thai Women: Lessons Learned.

A prospective study conducted in a Thai general practice clinic demonstrated a high prevalence (91.3%) of inappropriate empirical antibiotic use in women with uncomplicated cystitis and 42.6% Escherichia coli fluoroquinolone resistance. An annual update of antimicrobial resistance surveillance data of uropathogens may permit targeted treatment of patients in hospital care.

Fosfomycin for the Treatment of Cystitis in the Abdominal Solid Organ Transplant Population.

To evaluate the use of fosfomycin (FOS) at the single-dose regimen approved by the U.S. Food and Drug Administration as well as off-label multidose regimens for the treatment of cystitis after abdominal solid organ transplant (aSOT). Retrospective study. Tertiary academic medical center. Adult inpatients with history of aSOT receiving FOS between January 1, 2009, and April 30, 2015, for the treatment of cystitis. Seventy-six courses of FOS were identified in 64 patients. Overall treatment success was 85.5%, with 11 failed treatment courses. Enterococcus was isolated in 59.3% of courses, of which 72.2% were vancomycin-resistant enterococci (VRE). Gram-negative organisms comprised a quarter of isolated bacteria, with most resistant to three or more antimicrobial classes. In the 11 failed treatment courses, 90% were targeted against enterococcus, of which 82% were VRE. Six of these failures (54%) were successfully retreated with uroselective therapy (FOS or nitrofurantoin). No significant difference in the success rate of single-dose versus multidose therapy was seen (80.6% vs 90%, p=0.33). Concomitant systemic antibiotics for other indicationswere present in 36.8% of courses, and they were significantly more frequent in the multidose group (67.5% vs 47.2%, p=0.04). However, multivariable logistic regression analysis found that after adjustment for broad-spectrum antibiotic use, no statistically significant difference in failure rates was found between the two regimens (p=0.42). FOS appears to be successful in the treatment of cystitis in aSOT recipients. Multidose therapy did not significantly improve success over a single-dose regimen. Further prospective studies are needed to elucidate the true efficacy of FOS in the aSOT population.

Canephron\xae N in the treatment of recurrent cystitis in women of child-bearing Age: a randomised controlled study

BackgroundThe aim of this study was to investigate the effect of the herbal medicine Canephron®N, particularly regarding its ability to prevent recurrences of cystitis, associated with E.Coli in women of child-bearing age.MethodsNinety patients were randomised into two treatment groups. Both, the test group (n = 45) and the control group (n = 45), received an antibacterial therapy (fluoroquinolones) for 7 days determined by urine culture. Furthermore, in both groups general recommendations on preventing cystitis were made (sufficient liquid consumption, avoidance of hypothermia etc.). The test group received an additional Canephron®N therapy for 3 months (2 tablets, three times a day).Control examinations were conducted on day 7 and after 3, 6 and 12 months; or immediately in the case of a recurrent episode. The following cystitis symptoms were recorded at each time point: pain in the bladder, burning and stinging during urination, urinary urgency and frequent urination in small amounts. The criteria for defining a recurrent episode of cystitis were rebound lower urinary tract infection symptoms with pyuria and positive bacteriological urine culture.ResultsCanephron®N in addition to fluoroquinolones helps to reduce cystitis symptoms after 7 days better compared to treatment with fluoroquinolones only, as well as pyuria after 3, 6 and 12 months and urine levels of E. coli at 3 and 12 months.The frequency rate of recurrent episodes of cystitis was in the test group always lower than in the control group with a statistically significant difference at 6 months (8.9% vs. 17.8%) and at 12 months (15.5% vs. 35.5%). At 12 months, the mean score of the LUTI Symptom Severity Index was 6 (p ≤ 0.05) in the control patients and 3 (p ≤ 0.05) in the test patients. This may indicate that the relapses were less severe in the test group.ConclusionTreatment with the herbal medicine Canephron®N is a novel treatment method of alleviating the symptoms of cystitis and especially for reducing the rate of recurrent cystitis episodes.

Effective treatment of ketamine-associated cystitis with botulinum toxin type a injection combined with bladder hydrodistention.

ObjectiveKetamine-associated cystitis (KAC) has been described in a few case reports, but its treatment in a relatively large number of patients has not been documented. This study aimed to describe our experience of treatment of 36 patients with KAC.MethodsThirty-six patients (30 males and 6 females, aged 19–38 years) with KAC, who had previously taken a muscarinic receptor blocker and/or antibiotics, but without symptomatic relief, were treated with botulinum toxin A injection combined with bladder hydrodistention. Urodynamic testing, and the O’Leary–Sant interstitial cystitis symptom index (ICSI) and problem index (ICPI) were used to evaluate baseline values and improvement before and after the treatment.ResultsOne month post-treatment, all patients achieved marked relief of symptoms. The nocturia time was markedly reduced, while bladder capacity, the interval between micturition, the void volume, and the maximum flow rate were remarkably increased at 1 month. Additionally, the ICSI and ICPI were significantly improved.ConclusionBotulinum toxin A injection along with bladder hydrodistention is effective for managing KAC.

Purple corn silk: A potential anti-obesity agent with inhibition on adipogenesis and induction on lipolysis and apoptosis in adipocytes

Ethnopharmacological relevanceCorn silk or the stigma of Zea mays L. has traditionally been used in weight loss stimulation and treatment of cystitis, urinary infections and obesity. Purple corn silk, rich of polyphenolic substances, was reported on anti-diabetic and anti-obesity effect in animal studies. However, scientific evidence on mechanisms and targets of action of purple corn silk related to adipocyte life cycle has been limited. Aim of studyTo determine phytochemical compositions and investigate anti-obesity potential of the purple corn silk focusing on interruption of adipocyte life cycle; effect on pre-adipocyte proliferation, adipogenesis, adipocyte lipolysis, and apoptosis. Materials and methodsThe ethanolic purple corn silk extract (PCS) was prepared and investigated for phytochemical compositions by LC/MS/MS technique and anti-obesity potential using murine 3T3-L1 cell line. Using methyl thiazole tetrazolium (MTT) assay, the effects on pre-adipocytes and adipocyte viability and on pre-adipocytes proliferation at 24-, 48-, and 72-h incubation period were evaluated. In addition, anti-adipogenesis via inhibition on adipocyte differentiation and reduction of total lipid accumulation was evaluated using Oil Red O staining and spectrophotometric methods, respectively. The lipolysis effect was determined by measurement of glycerol released content using glycerol test kit after 48-h treatment of PCS to adipocytes. Apoptosis inductive effect was done by using 2-(4-Amidinophenyl)-6-indolecarbamidine dihydrochloride (DAPI) staining method. ResultsThe polyphenols including anthocyanins, quercetin and phenolic acids and derivatives were found as the major chemical compositions of the PCS. With multiple-stages interruption on the adipocyte life cycle, anti-obesity effect of PCS was interestingly demonstrated. When compared to the control, the PCS at concentration range between 250–1000 μg/mL showed anti-adipogenesis effect as expressing of significant inhibition on pre-adipocyte proliferation at all incubation period (43.52±5.28 – 75.51±9.09%) and significant decreasing of total lipid accumulation at concentration of 500μg/mL (80.22±6.58%) and 1000μg/mL (69.62±5.42%). Moreover, the PCS exhibited lipolysis and apoptosis inductive effect with dose dependent manner and significance at concentration of 1000μg/mL by increase of released glycerol content (173.88±6.13% of the control) and of nuclei condensing and apoptotic bodies (with relative apoptosis induction as 131.74±1.64% of the control). ConclusionOur data has evidenced the anti-obesity potential of PCS related interruption at multiple stages of adipocyte life cycle. Its potency was attributed to inhibition on adipocyte proliferation and adipogenesis as well as induction on lipolysis and apoptosis at high concentration. However, further in vivo investigation should be considered to insist the possibility in applications of PCS in prevention and treatment of obesity.

424 - Efficacy of botulinum toxin A for the treatment of interstitial cystitis to improve quality of life: A systematic review

424 - Efficacy of botulinum toxin A for the treatment of interstitial cystitis to improve quality of life: A systematic review

Dimethyl sulfoxide (DMSO) as intravesical therapy for interstitial cystitis/bladder pain syndrome: A review.

The purpose of this review is to update the current understanding of dimethyl sulfoxide (DMSO) and its role in the treatment of interstitial cystitis (IC). A systematic review was conducted using the PRIMSA checklist to identify published articles involving intravesical DMSO for the treatment of IC. Thirteen cohort studies and three randomized-controlled trials were identified. Response rates relying on subjective measurement scores range from 61 to 95%. No increased efficacy was found with "cocktail" DMSO therapy. Great variation existed in diagnostic criteria, DMSO instillation protocols and response measurements. The current evidence backing DMSO is a constellation of cohort studies and a single randomized-controlled trial versus placebo. The optimal dose, dwell time, type of IC most likely to respond to DMSO, definitions of success/failure and the number of treatments are not universally agreed upon. Improvements in study design, phenotyping patients based on symptoms, as well as the emergence of reliable biomarkers of the disease may better guide the use of DMSO in the future.

A Head-to-Head Comparative Phase II Study of Standard Urine Culture and Sensitivity Versus DNA Next-generation Sequencing Testing for Urinary Tract Infections.

Many studies have discussed clinical practice guidelines for the treatment of cystitis and pyelonephritis. Treatment of uncomplicated urinary tract infections (UTIs) can be based on empiric antibiotic therapy. For complicated or recurrent UTIs, therapy can be based on laboratory-controlled culture and sensitivity (C&S) reports. The diagnosis of UTI by clinical criteria alone has an error rate of up to 33%. In addition, positive laboratory culture results do not always indicate a diagnosis of UTI. Comparison of urine in a conventional culture model versus DNA next-generation sequencing (NGS) to accurately identify and provide information on resistance factors (mobile genetic elements) is warranted. Our study was a head-to-head comparative phase II study of standard urine C&S versus DNA NGS testing for the diagnosis and treatment efficacy in patients with symptoms of acute cystitis based on short-term outcomes.

Hyperbaric oxygen therapy for hemorrhagic radiation cystitis

Background: Radiation cystitis with macroscopic hematuria is a frustrating clinical problem for urologists. Since 1985, hyperbaric oxygen therapy (HBOT) has been applied as a treatment for radiation cystitis with macroscopic hematuria; numerous studies have shown that this treatment has favorable results. Purpose: The purpose of this study was to elucidate the HBOT affected the clinical outcomes and treatment of hemorrhagic radiation cystitis (HRC). Methods: Between November 1989 and June 2014, 42 patients (39 women and three men) with HRC were treated with hyperbaric oxygen at a pressure of 2.5 atmospheres absolute, breathing 100% O2for 120 min in a multiplace hyperbaric chamber. Results: After an average of 38 hyperbaric oxygen sessions, macroscopic hematuria was completely halted in 35 patients (83.3%) and markedly decreased in three patients (7.1%). A comparison of cystoscopic findings before and after HBOT showed significant decreases in both hemorrhagic sites and telangiectasis of the bladder mucosa. The mean follow-up was 20.7 months (range: 3–49 months). No cases exhibited evidence of barotrauma or oxygen toxicity. One patient underwent a urodynamic study both before and after HBOT, with several changes in bladder function observed after HBOT: urine peak flow increased from 12.8 mL/s before HBOT to 15.0 mL/s after HBOT and urine mean flow increased from 6.5 mL/s to 8.9 mL/s. Urine voiding time decreased from 40.0 s to 28.0 s, urine flow time from 39.0 s to 28.0 s, time to peak flow from 15.0 s to 8.0 s, and voided volume from 251 mL to 248 mL. Conclusion: The results of this study suggest that early application of HBOT is a safe and effective treatment method for HRC. Whether HBOT is beneficial to urinary bladder function requires further study with a larger patient cohort enrolled.

Impact of Education on Fluoroquinolone Use in Uncomplicated Cystitis

BackgroundThe Food and Drug Administration released a safety alert in May 2016 against the use of fluoroquinolones (FQ) in uncomplicated infections including uncomplicated cystitis due to concern for increased risk of disabling and potentially permanent adverse drug effects (ADEs). The aim of the study is to compare the rates of FQ prescriptions for uncomplicated cystitis before and after prescriber education to assess if prescriber education decreases the use of FQs.MethodsThis is a single-center, two-phase retrospective chart review comparing a five year pre-intervention and a four month post-intervention periods that evaluated patients seen at UC Irvine’s emergency department (ED) or outpatient clinics for uncomplicated cystitis. Adult female, non-pregnant patients 18 years of age or older with the diagnosis of uncomplicated cystitis were included. The treatment guideline for uncomplicated cystitis was developed by the antibiotic stewardship subcommittee with the recommendation to use nitrofurantoin as the first line agent. The infectious diseases pharmacy resident provided educational sessions from December 2016 to January 2017. The primary objective is to evaluate the impact of prescriber education on FQ prescribing rates for uncomplicated cystitis in the ED and outpatient clinics. Secondary objectives include the resistance rates of FQ and trimethoprim/sulfamethoxazole (TMP/SMX) against uropathogens to determine the local resistance rates and ADEs due to FQs.ResultsA total of 1056 patients were included in the analysis: 974 in the pre-intervention and 82 in the post-intervention groups. The rate of FQ prescriptions decreased from 32.3% in the pre-intervention group to 13.1% in the post-intervention group (P = 0.0002). The overall resistance rates of uropathogens were 19.3% to FQ and to 34.3% to TMP/SMX. There were 5 (0.5%) ADEs in the pre-intervention and 2 (2.5%) in the post-intervention groups.ConclusionPrescriber education regarding the appropriate treatment of uncomplicated cystitis and proper use of FQs was effective in reducing the rate of FQ prescriptions in management of uncomplicated cystitis. After prescriber education, the rate of FQ prescriptions decreased by 59%.Disclosures All authors: No reported disclosures.

Treatment of radiation-induced cystitis and vulvodynia via a ganglion impar block using a lateral approach under computed tomography guidance: a case report.

Adjuvant radiation therapy (RT) after colorectal cancer surgery can prevent local recurrence, but has several side effects. Precise injection of drugs into the affected areas is complicated by radiation-induced fibrosis of soft or connective tissue. A 48-year-old woman experienced severe intractable perineal pain, dysuria, urinary urgency, and frequent urination after rectal cancer surgery and adjuvant RT, and was diagnosed with radiation-induced cystitis and vulvodynia. Her symptoms persisted despite two fluoroscopy-guided ganglion impar blocks. Fluoroscopy revealed atypical needle tip positioning and radiolucent dye distribution, presumably due to radiation-induced fibrosis in the target region. We performed two computed tomography (CT)-guided ganglion impar blocks by using a lateral approach, which allowed more accurate po-sitioning of the needle tip. Her pain visual analog score decreased from 9 to 3, and she recently resumed sexual intimacy. CT guidance is a viable alternative to fluoroscopy guidance when performing ganglion impar blocks in fibrotic areas.

USE OF NEW EUROPEAN FURAZIDINIUM IN THERAPY OF ACUTE INFECTIONS OF THE URINARY TRACTS IN WOMEN

Uncomplicated infection of lower urinary tract is one of most common reason to visit a doctor among women. Statistically there are about 36 million cases of acute cystitis registered yearly in Russia. The treatment of acute cystitis is usually empirical, that’s why it is very important to know etiology of the disease. There are some criteria for drug choice for the disease treatment: the sensitivity range of uropathogenic microflora, the effectiveness of a preparation based on clinical trials, tolerance of the patient to the antibacterial drug, low risk of collateral damage, availability of the drug and its price. The author has assessed the treatment effectiveness of Urofuragin (Furazidinum) preparation in case of acute cystitis. This drug is high active against main causative agents of the infection diseases of lower urinary tract. Due to the results of the research cupping of dysuria, hematuria and pain syndrome were recorded in all clinical groups on the 2nd-3rd day of treatment. Normalization of urinalysis had place in 98% of cases (51 patient). Only 4 patients (7,6%) had unwanted side effects during the treatment time: nausea, loss of appetite. All the unwanted side effects were poorly expressed and didn’t require to withdraw the treatment. The results of this research show that Urofuragin (Furazidinum) is an effective antibacterial preparation which is easy to use, has affordable price, wide indications and good tolerance to the drug.

Impact of an antimicrobial stewardship intervention on antibiotic prescribing practices for community-acquired acute uncomplicated cystitis in the emergency department

BackgroundIn the emergency department (ED) acute cystitis is often treated empirically. It is recommended that fluoroquinolones (FQs) be reserved for those who do not have alternative treatment options. The purpose of this study was to assess an antimicrobial stewardship intervention on prescribing practices for community-acquired acute uncomplicated cystitis in the ED.MethodsA controlled quasi-experimental antimicrobial stewardship education and quality improvement intervention study in the ED consisting of three phases: (1) pre-intervention- historical data collection (7 months), (2) pharmacists’ provision of provider education (2 months), and (3) post-intervention observational data collection (7 months). Patients included were >18 years of age with diagnosis of acute uncomplicated cystitis in the ED and urine culture positive for E. coli. Patients were excluded if diagnosed with pyelonephritis, received intravenous antibiotics, or treated for healthcare-associated infection. The primary outcome was incidence of FQ prescriptions before-and-after the antimicrobial stewardship intervention. Secondary outcomes were incidence of E. coli susceptibility to empiric treatment, ED specific treatment algorithm adherence, and 30-day revisit to the ED. Chi-square and Fisher’s exact statistical tests were used to analyze outcomes.ResultsThe study included 174 patients, 90 in the pre-intervention and 84 in the post-intervention groups. Patients were predominantly young African-American females. Upon provision of pharmacists’ education, empiric FQ prescribing for acute uncomplicated cystitis decreased from 38.9% to 13.1%, pre and post-intervention, respectively (P < 0.001). Adherence to the ED specific antibiogram and treatment algorithm improved from 35.6% to 74% in the pre and post-intervention groups, respectively (P < 0.001). There was no difference pre and post-intervention for incidence of E. coli susceptibility to empiric antimicrobial treatment and 30-day revisit to the ED.ConclusionAn antimicrobial stewardship intervention in the ED significantly reduced fluoroquinolone use for the treatment of acute uncomplicated cystitis and increased adherence to acute uncomplicated cystitis treatment guidelines.Disclosures All authors: No reported disclosures.

Efficacy of Third Party BK Virus (BKV) Specific Cytotoxic T-Lymphocytes Generated By Ex Vivo Expansion for the Treatment of BKV Infection in Stem Cell Transplant Recipients, a Phase 2 Trial

Clinical manifestations of BKV hemorrhagic cystits (HC) following hematopoietic stem cell transplantation (HSCT) range from microscopic hematuria to bladder hemorrhage and renal failure. Pharmacologic treatments for HC have limited efficacy and significant adverse effects.Here, we report the preliminary analysis of adoptive immunotherapy with most closely HLA-matched third party BKV-specific CTL lines (BKV-CTLs) generated by ex vivo expansion.We generated a bank of BKV-specific CTLs from 17 virus-immune healthy donors (mean age, 55; range, 25 to 75 years). Mononuclear cells enriched from donor buffy coats were stimulated with BKV peptide mix from capsid proteins VP1, VP2, VP3, large T antigen (LT) and small T antigen (ST) in the presence of IL-2, IL-7 and IL-15 for 14 days. At the end of culture, the cells were harvested and cryopreserved until use.Patients with symptomatic BKV cystitis after HSCT for leukemia or lymphoma were eligible. Patients with acute GVHD grades II-IV, those receiving >0.5 mg/kg systemic steroids/day or on treatment with cidofovir or leflunomide were excluded. A search for the most closely HLA-matched donor was initiated through the MDACC cell therapy donor bank. BKV-specific T cells were infused intravenously directly after thawing. Patients could receive up to 2 infusions.BKV PCR and clinical symptoms were monitored every week for 28 days after infusion. Complete response was defined as complete resolution of symptoms and gross hematuria and partial response (PR) as decrease in grade of HC from 3 (urinary blood clots) or 4 (red cell transfusion requirement/renal impairment) to 2 (macroscopic hematuria) or 3 respectively. Patients with stable disease (SD) or progression had insufficient changes to qualify as PR or had an increase in symptoms or worsening hematuria, respectively.To date, 10 patients (2 HLA-matched related, 5 HLA-matched unrelated and 3 haploidentical HSCT recipients) have received BKV-CTLs for BK cystitis. The median number of BKV-specific CD3+IFN-gamma+ and CD3+IL-2+ T-cells infused was 10e3/kg and 4.8e3/kg, respectively. The ratio of BKV-specific CD4+/CD8+ T cells in the infused product was 7.8 (range 3.1-22.1). There were no infusion-related adverse effects. Based on end-organ response, BKV-CTLs controlled infection in 9/9 evaluable patients with BKV cystitis (4 CRs and 5 PRs)- one patient was not evaluable due to disease relapse, sepsis and anuria. All patients achieved a response by day 14 post-infusion. Two of 5 patients with PR received a second BK CTL infusion from a different donor. One had an initial PR to the first CTL infusion but symptoms progressed after 6 weeks. A second infusion resulted in a PR with reduction in BKV PCR and symptoms. The other patient achieved CR within 28 days of the second infusion. The time to second infusion was 6 and 3 weeks, respectively. The response in all patients was sustained.Following infusion, we detected high frequencies of polyfunctional BKV-specific CD4+ and CD8+ T-cells, capable of producing IL-2, IFN-gamma and TNF-alpha in response to ex vivo stimulation with BKV peptide pools (VP1, VP2, VP3, LT and ST). The response was mainly CD4+ T cell dominant, reflecting the composition of the infused BKV T cell line and consistent with previous reports of a predominantly CD4-mediated T cell response in BKV infection.De novo grade 2-4 acute graft versus host disease (aGVHD) occurred in 1/10 patients. The patient developed grade 2 duodenal GVHD 14 days following infusion. A second patient had recurrence of a prior skin GVHD and developed grade 2 aGVHD 9 days after infusion. Both were successfully treated with 1mg/kg/day systemic steroids.This analysis demonstrates the safety, feasibility and efficacy of administration of most closely HLA-matched BKV CTLs for the treatment of BKV cystitis in HSCT patients. The response rate of 100% in the first 10 patients treated with BKV CTLs is promising. DisclosuresCiurea:Cyto-Sen Therapeutics: Equity Ownership; Spectrum Pharmaceuticals: Other: Advisory Board.

Histone deacetylase inhibitors mediate DNA damage repair in ameliorating hemorrhagic cystitis.

Hemorrhagic cystitis is an inflammatory and ulcerative bladder condition associated with systemic chemotherapeutics, like cyclophosphomide. Earlier, we reported reactive oxygen species resulting from cyclophosphamide metabolite, acrolein, causes global methylation followed by silencing of DNA damage repair genes. Ogg1 (8-oxoguanine DNA glycosylase) is one such silenced base excision repair enzyme that can restore DNA integrity. The accumulation of DNA damage results in subsequent inflammation associated with pyroptotic death of bladder smooth muscle cells. We hypothesized that reversing inflammasome-induced imprinting in the bladder smooth muscle could prevent the inflammatory phenotype. Elevated recruitment of Dnmt1 and Dnmt3b to the Ogg1 promoter in acrolein treated bladder muscle cells was validated by the pattern of CpG methylation revealed by bisulfite sequencing. Knockout of Ogg1 in detrusor cells resulted in accumulation of reactive oxygen mediated 8-Oxo-dG and spontaneous pyroptotic signaling. Histone deacetylase (HDAC) inhibitor, suberoylanilide hydroxamic acid (SAHA), restored Ogg1 expression in cells treated with acrolein and mice treated with cyclophosphamide superior to the standard of care, mesna or nicotinamide-induced DNA demethylation. SAHA restored cyclophosphamide-induced bladder pathology to that of untreated control mice. The observed epigenetic imprinting induced by inflammation suggests a new therapeutic target for the treatment of hemorrhagic cystitis.

Protective Effect of Intravesical Platelet-Rich Plasma on Cyclophosphamide-Induced Hemorrhagic Cystitis

Hemorrhagic cystitis (HC) is the most common urotoxic side effect of cyclophosphamide (CYP). Platelet rich plasma (PRP) plays an important role in wound healing and inflammatory responses. The aim of this study was to investigate the efficacy of intravesical PRP at treatment of interstitial cystitis (IC). Female rats (n=24) were used. IC was induced by intraperitoneal injection of cyclophosphamide (CYP). Rats were randomly allocated to one of four groups (n = 6 per group): a control group; a sham group with saline (75 mg/kg; i.p.) instead of CYP on day 1; a IC group, which was injected with CYP (150 mg/kg; i.p.) on day 1; and, a intravesical PRP‑treated group which was injected with CYP (150 mg/kg; i.p.) on day 1. On day 2, the rats in each group were sacrificed under anesthesia. Histological evaluation showed that bladder inflammation in CYP‑treated rats was not suppressed by PRP. CYP administration induced severe IC with marked edema, hemorrhage and inflammation in CYP and CYP+PRP groups, but PRP was not found to be effective to decrease these effects. The application of PRP could not reverse the histopathological changes in rats that had interstitial cystitis due to the cyclophosphamide injection.

Protective Effect of Intravesical Platelet-Rich Plasma on Cyclophosphamide-Induced Hemorrhagic Cystitis

Purpose: Hemorrhagic cystitis (HC) is the most common urotoxic side effect of cyclophosphamide (CYP). Platelet rich plasma (PRP) plays an important role in wound healing and inflammatory responses. The aim of this study was to investigate the efficacy of intravesical PRP at treatment of interstitial cystitis (IC). Material-Methods: Female rats (n=24) were used. IC was induced by intraperitoneal injection of cyclophosphamide (CYP). Rats were randomly allocated to one of four groups (n = 6 per group): a control group; a sham group with saline (75 mg/kg; i.p.) instead of CYP on day 1; a IC group, which was injected with CYP (150 mg/kg; i.p.) on day 1; and, a intravesical PRP‑treated group which was injected with CYP (150 mg/kg; i.p.) on day 1. On day 2, the rats in each group were sacrificed under anesthesia. Results: Histological evaluation showed that bladder inflammation in CYP‑treated rats was not suppressed by PRP. CYP administration induced severe IC with marked edema, hemorrhage and inflammation in CYP and CYP+PRP groups, but PRP was not found to be effective to decrease these effects. Conclusion: The application of PRP could not reverse the histopathological changes in rats that had interstitial cystitis due to the cyclophosphamide injection.

A comparative study on phytochemical investigation and pharmacological screening of Platycladus orientalis and Ocimum canum

In ayurveda, plants have been used for the treatment of so many diseases. Herbal drugs are easily available and have fewer side effects. So, many people are attracted towards the herbal drugs. Platycladus orientalis is one of the useful plant in Indian & Chinese medicine. It is used in treatment of so many diseases like diuretic, anticancer, anticonvulsant, stomachic, antipyretic, analgesic and anthelmintic etc. In Zimbabwe, Mozambique and South Africa Platycladus orientalis is grown as an ornamental. The essential oils extracted from leaves, cones and wood are important in body care products used in the Western world. Platycladus orientalis (Commonly- Morpankhi, Family- Cupressaceae) is an evergreen, monoecious trees or shrubs used in various forms of traditional medicines and homeopathy in various ways. In traditional practices Thuja is used for treatment of bronchial catarrh, enuresis, cystitis, psoriasis, uterine carcinomas, amenorrhea and rheumatism. Recent re-searches in different parts of the world have shown that p. orientalis and its active component thujone have the great potential against a various health problems The medicinal plants are widely used by the traditional medical practitioners for curing various diseases in their day to day practice. In traditional systems of medicine, different parts (leaves, stem, flower, root, seeds and even whole plant) of Ocimum canum Linn (known as kalaTulsi in Hindi), a small herb seen throughout India, have been recommended for the treatment of bronchitis, bronchial asthma, malaria, diarrhea, dysentery, skin diseases, arthritis, painful eye diseases, chronic fever, insect bite etc. The Ocimum canum L. has also been suggested to possess antifertility, anticancer, antidiabetic, antifungal, antimicrobial, hepatoprotective, cardioprotective, antiemetic, antispasmodic, analgesic,adaptogenic and diaphoretic actions.

Uropathogen distribution and antimicrobial susceptibility in uncomplicated cystitis in Belgium, a high antibiotics prescribing country: 20-year surveillance

Treatment of cystitis in primary care is usually empirical, guided by the prior probability of causal pathogens and their susceptibility. To re-evaluate empirical treatment guidelines, the actual distribution and susceptibility of uropathogens was examined and compared with two previous surveys in Belgium over the past 20years. Because of the alarming increase in carriage of extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Escherichia coli, this specific resistance was explored. From May 2014 to December 2015, 120 general practitioners collected midstream urine specimens from adult pre- and postmenopausal female patients with suspected cystitis. A dipslide was inoculated and sent for microbiological analysis. Anal swabs were collected for ESBL and carbapenemase detection. Of 265 enrolled patients, 203 (79.3%) had a positive culture. Escherichia coli (81.6%) was the most frequently isolated uropathogen, followed by Staphylococcus saprophyticus (8%), confirming the results of the 1995 and 2005 surveys. The susceptibility of E. coli remained nearly 100% for nitrofurantoin and fosfomycin, decreased from nearly 100% in 1995 to 94.2% for quinolones, from 73.2 to 55.5% for ampicillin, and from 83.3 to 76.3% for trimethoprim-sulfamethoxazole (TMP-SMX). In E. coli present in positive urine cultures, ESBLs were found in 2.5% and carbapenemases were absent. In fecal specimens, ESBL-producing E. coli were found in 7.9% and carbapenemases were not detected. Over a 20-year period, the distribution of uropathogens in women with cystitis remained unchanged. Susceptibility remained excellent for nitrofurantoin and fosfomycin. For TMP-SMX, ampicillin, and quinolones, there was a decrease.

Prevalence of antibiotic susceptibility and resistance of Escherichia coli in acute uncomplicated cystitis in Korea: Systematic review and meta-analysis.

Background:The aim of this study is to determine the prevalence of antibiotic susceptibility and resistance of Escherichia coli Escherichia coli (E coli) in female uncomplicated cystitis in Korea using meta-analysis.Methods:A cross-search of the literature was performed with MEDLINE for all relevant data published before October 2015 and EMBASE from 1980 to 2015, the Cochrane Library, KoreaMed, RISS, KISS, and DBPia were also searched. Observational or prospective studies that reported the prevalence of antimicrobial susceptibility and resistance of E coli were selected for inclusion. No language or time restrictions were applied. We performed a meta-analysis using a random effects model to quantify the prevalence of antimicrobial susceptibility and resistance of E coli.Results:Ten studies were eligible for the meta-analysis, which together included a total of 2305 women with uncomplicated cystitis. The overall resistance rate to antibiotics was 0.28 (95% confidence interval [CI]: 0.25, 0.32). The pooled resistance rates were 0.08 (95% CI: 0.06, 0.11) for cephalosporin, 0.22 (95% CI: 0.18, 0.25) for fluoroquinolone (FQ), and 0.43 (95% CI: 0.35, 0.51) for trimethoprim/sulfamethoxazole (TMP/SMX). Regression analysis showed that resistance to FQ is increasing (P = 0.014) and resistance to TMP/SMX is decreasing (P = 0.043) by year. The generation of cephalosporin was not a significant moderator of differences in resistance rate.Conclusion:The resistance rate of FQ in Korea is over 20% and is gradually increasing. Although the resistance rate of TMP/SMX is over 40%, its tendency is in decreasing state. Antibiotic strategies used for the treatment of uncomplicated cystitis in Korea have to be modified.