Treatment Of Cystitis In Women Research Articles

Recurrent cystitis: how to achieve perfection in treatment?

Introduction. Urinary tract infections are the second most common type of bacterial infections worldwide. Treatment of patients with chronic (recurrent) cystitis remains challenging and requires an individual approach.Aim. To assess the efficacy of combined therapy for exacerbation of chronic cystitis.Materials and methods. A total of 65 women aged 18–48 years were enrolled in an open comparative bidirectional study. All participants received antibacterial therapy for exacerbation of chronic cystitis in accordance with the clinical guidelines for the treatment of cystitis in women. After the therapy was completed, the comparison group (35 patients) did not receive any drugs, whereas 30 patients from the treatment group were prescribed Cystenium II biologically active dietary supplement at a dose of 1 orally disintegrating tablet twice daily for 2 weeks. The examination included a measurement of the severity of complaints using the Acute Cystitis Symptom Score (ACSS), a clinical urinalysis and urine culture + sensitivity test. The efficacy of treatment was assessed following completion of antibiotic therapy and two weeks after the therapy.Results. After finishing antibiotic treatment, no patient has achieved full recovery (improvement of urinalyses, no growth of pathogenic microbial flora, no complaints). Both groups showed statistically significant decreases in ACSS scores on Visit 2. Over the following two weeks, the symptoms in the comparison group did not change (p > 0.05), and in the treatment group the sum of scores continued to decrease, reaching an average of 3.62 ± 0.42, which is 5.5 times less than the baseline level and almost 3 times less than the sum of scores following completion of antibacterial therapy (p < 0.05). The positive changes in leukocyturia and bacteriuria were also more pronounced in the treatment group.Conclusion. After completion of antibiotic therapy for relapse of chronic (recurrent) cystitis, the patients usually have residual effects that cannot be regarded as presentations of an active disease, but they disturb patients. A two-week course of pathogenetic therapy with a combination drug containing A-type Vaccinium macrocarpon proanthocyanidins, vitamin C and D-mannose to be received as the second step can increase the efficacy of treatment.

DIAGNOSTICS AND METHODS OF TREATMENT OF POSTCOITAL CYSTITIS. TRANSPOSITION OF THE DISTAL URETHRA

This paper provides information on the presence, frequency of manifestation, diagnosis and treatment of postcoital cystitis in women. Cystitis is the most common disease of the urinary system in women and sexual activity is one of the most important factors in the genesis of inflammatory diseases of the lower urinary tract in women.

Аpplication of nifuratel in treatment of cystitis in women

Cystitis is the most common pathology of the urinary tract in women both in our country and abroad. The high incidence of this disease in women in the population is influenced by anatomical, physiological features of the female body, violations of personal and sexual hygiene, burdened with an obstetric and gynecological (OAG) history, etc. In the current domestic and foreign recommendations for the diagnosis and treatment of cystitis in women, it is noted that in the vast majority of cases (up to 80% cases), the causative agent of cystitis is Escherichia coli, sensitive to nitrоfuran drugs.The purpose of the work. To demonstrate the effectiveness of the use of nifuratel (Nifuratel-SZ, Northern Star Co., Russia) in women with cystitis of various age groups using clinical examples. In the first clinical example, the high effectiveness of the use of nitrоfuran was shown in a woman of active reproductive age with OAG, in the second, in a teenager with an acute inflammatory process, in the 3rd-in a postmenopausal patient with concomitant multiple organ pathology.Conclusion. Nifuratel (Nifuratel-SZ, Northern Star Co., Russia) has proven to be a highly effective and safe drug with a wide range of antibacterial effects in patients with cystitis of different age groups.

Нетипичные случаи рецидивирующего посткоитального цистита у женщин: приобретенная гипермобильность уретры

Introduction. Recurrent postcoital cystitis is considered as a disease that is a consequence of certain congenital prerequisites in the structure of the lower parts of the urogenital tract in women. Materials and methods. When writing the article, we used data on the surgical treatment of recurrent postcoital cystitis in women, posted in the PubMed databases (https://www.ncbi.nlm.nih.gov/pubmed/) and the Scientific Electronic Library Elibrary.ru (https://elibrary.ru/). When searching the databases, the following keywords were used: postcoital cystitis , honeymoon cystitis , acquired postcoital cystitis , hymenotomy , urethrogenital adhesions ( postcoital cystitis , honeymoon cystitis , acquired postcoital cystitis , transposition of the urethra , hymenotomy , urethro-hymenal fusion ). Results. Patients with recurrent postcoital cystitis represent a heterogeneous group from an etiological point of view. A detailed analysis of complaints and anamnesis of the disease, as well as the causes, conditions and time of recurrence of cystitis helps to clarify the pathogenesis of the disease in each case. The article presents clinical cases of acquired recurrent postcoital cystitis in women who have previously undergone surgery on the lower urinary tract. Conclusion. Recurrent postcoital cystitis can be the result of not only congenital anatomical prerequisites, but also acquired changes in the urogenital area due to surgery or injury.

Посткоитальный цистит: хирургическое лечение

Introduction. Urinary tract infection is one of the most common urological infectious diseases. An important risk factor for uncomplicated urinary tract infection in women is sexual intercourse. Post-coital cystitis is a special form of recurrent cystitis, associated with a low location of the external urethral orifice. This condition is called vestibulo-vaginal dislocation of the urethra. Materials and methods. PubMed and Elibrary (Scientific Electronic Library) databases were searched for studies describing surgical treatment of recurrent post-coital cystitis in women. Based on the relevance and reliability of the sources, 23 articles in peer-reviewed medical journals were selected. All of the selected studies contained data on evolution of surgical treatment approaches for post-coital cystitis. Results. In the middle of the 20th century the interest of medical community in surgical treatment of post-coital cystitis has gradually faded. Such trend was caused by imperfect surgical techniques of existing procedures (O'Donnell and Hirschhorn operations). Subsequent accumulation of experience, over several decades, allowed to establish possible mistakes in diagnosis and operation techniques. Furthermore, a constant search for new techniques and improvement of existing ones minimized potential risk of complications. Great hopes are pinned on the works of B.K. Komyakov et al., who proposed extravaginal transposition of the urethra, that implies the transposition of the urethra and its external orifice as high as possible toward the clitoris. The technique is characterized by high efficacy and a low number of complications, as demonstrated by the treatment results of 228 patients diagnosed with post-coital cystitis. Conclusions. Various curative procedures for post-coital cystitis show the need to determine and standardize the optimal amount of surgical intervention for urethral dystopia in women.

War and Peace: the difficult treatment of urinary tract infections and fosfomycin trometamol

The title of this review “War and peace” is not accidental and the analogies with a well-known literary masterpiece have absolutely justified ground. As in the case of Lev Tolstoy’s novel this title has a profound philosophical meaning, although at first glance it may seem quite obvious. The word «war» may well correspond to those hostile changes of microorganisms leading to the current problem of antimicrobial resistance recognized worldwide. This is the “war” we have to wage against the antibiotic-resistant bacteria today. And the «peace» in this context is considered as the world, the entire universe, all people, the whole society and its reaction to what is happening. On the other hand, the word «peace» means something opposite in meaning to the word «war». Thus, the essence of the title bears a sharp contrast between military actions and peacetime, between something that carries a threat to life and peace, or illness and recovery. Preserving original novel’s structure the authors of this review consistently consider justification of fosfomycin trometamol as a first-line drug in the treatment of acute uncomplicated cystitis in women taking into account the latest research, publications and global trends.

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.

Use of Kanefron in treatment of acute uncomplicated cystitis in women

The aim of study was to evaluate the efficacy and safety of Kanefron with uncomplicated cystitis in women in clinical practice. Patients and methods. In our work was attended by 22 women with a diagnosis of acute uncomplicated cystitis. The mean age was 29,0 ± 1,8 years (from 19 to 51 years. The criteria of effectiveness were changes in symptoms and laboratory parameters according to the urinary tests at Kanefron monotherapy. Results. After treating by Kanefron there were observed significant improvement in symptoms of acute cystitis. Before treatment the average symptom score was 8,05 ± 0,7 points, on the 3rd day of treatment it significantly decreased to 5,1 ± 1,0 points (p < 0,05) on day 7 of treatment it was up to 2, 9 ± 1,0 points, in the phase of observation of 37 days after initiation of therapy by Kanefron othe average score of symptoms was 0,1 ± 0,3 points. Frequency leukocyturia on the 7 day of treatment according to a study by urine microscopy was 83.3%, and by the 37 th day after the start of Kanefron (phase monitoring) significantly decreased to 37,5% (p < 0,05). Kanefron showed statistically significant antibacterial activity in acute cystitis. Prior to initiating therapy the growth of microorganisms at a titer of more than 100 000 units was detected in 72.7% of patients after 2 weeks of treatment (on day 37 of observation) - in 28,6% of patients (p < 0,05). Conclusions. Our results suggest that Kanefron can be an effective and well-tolerated alternative treatment of uncomplicated infections of the lower urinary tract in women, allowing to reduce the use of antibiotics. Appointment of the drug as a monotherapy Kanefron acute cystitis and duration of treatment requires further study and discussion.

14-Day Prulifloxacin Treatment of Acute Uncomplicated cystitis in Women with Recurrent Urinary Tract Infections: A Prospective, Open-Label, Pilot Trial With 6-Month Follow-Up

Recurrent urinary tract infections (UTI) are very common in otherwise healthy young women, and can have a very negative social and economic impact. In order to evaluate the tolerability and efficacy of a 14-day course of prulifloxacin orally administeredonce daily, 51 young female patients, attending the same STD center between may and June 2007 for symptoms of cystitis, with a history of recurrent UTI and urine culture positive for uropathogens, were enrolled in this prospective study. Microbiological and clinical efficacy was tested over three follow-up visits at 1, 3 and 6 months. Quality of life (QoL) was measured and the impact of prulifloxacin in modifying the Lactobacillus vaginal flora was also evaluated. At baseline, the pathogens most commonly isolated were Enterococcus faecalis (43.2%) and Escherichia coli (27.5%). 41 of the 51 women, (80.3%) had Lactobacillus spp. In vaginal samples at baseline. Microbiological results at follow-up examinations were as follows: after 1 month, 47 patients were recurrence-free and 4 had recurrence; after 3 months, 41 were recurrence free, while 6 reported recurrence; finally, after 6 months, 36 were recur-rence-free and 5 had recurrence. A statistically significant difference was reported between the QoL questionnaire mean scores at baseline (0.63), 1 (0.77), 3 (0.77) and 6months (0.78) after treatment (all p<0.001). The vaginal swab cultures demonstrated that Lactobacillus spp. Flora was maintained in 38 out of the 41 (92.6%) patients who had positive vaginal swab sample at baseline. In conclusion, a 14-day administration of prulifloxacin 600 mg is a safe, well tolerated and effective treatment for the management of UTI in young women.

Approach to urinary tract infections.

Urinary tract infection (UTI) is the most common infection experienced by humans after respiratory and gastro-intestinal infections, and also the most common cause of both community-acquired and nosocomial infections for patients admitted to hospitals. For better management and prognosis, it is mandatory to know the possible site of infection, whether the infection is uncomplicated or complicated, re-infection or relapse, or treatment failure and its pathogenesis and risk factors. Asymptomatic bacteriuria is common in certain age groups and has different connotations. It needs to be treated and completely cured in pregnant women and preschool children. Reflux nephropathy in children could result in chronic kidney disease; otherwise, urinary tract infections do not play a major role in the pathogenesis of end-stage renal disease. Symptomatic urinary tract infections occur most commonly in women of child-bearing age. Cystitis predominates, but needs to be distinguished from acute urethral syndrome that affects both sexes and has a different management plan than UTIs. The prostatitis symptoms are much more common than bacterial prostatic infections. The treatment needs to be prolonged in bacterial prostatitis and as cure rates are not very high and relapses are common, the classification of prostatitis needs to be understood. The consensus conference convened by National Institute of Health added two more groups of patients, namely, chronic prostatitis/chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis, in addition to acute and chronic bacterial prostatitis. Although white blood cells in urine signify inflammation, they do not always signify UTI. Quantitative cultures of urine provide definitive evidence of UTI. Imaging studies should be done 3-6 weeks after cure of acute infection to identify abnormalities predisposing to infection or renal damage or which may affect management. Treatment of cystitis in women should be a three-day course and if symptoms are prolonged, then a seven day course of antibiotics should be given. Selected group of patients benefits from low-dose prophylactic therapy. Upper urinary tract infection may need in-patient treatment. Treatment of acute prostatitis is 30-day therapy of appropriate antibiotics and for chronic bacterial prostatitis a low dose therapy for 6-12 months may be required. It should be noted that no attempt should be made to eradicate infection unless foreign bodies such as stones and catheters are removed and correctable urological abnormalities are taken care of. Treatment under such circumstances can result only in the emergence of resistant organisms and complicate therapy further.

Pivmecillinam in the treatment of urinary tract infections

The efficacy of pivmecillinam for empirical treatment of acute uncomplicated urinary tract infection (UTI) was initially reported in clinical trials published in the 1970s and 1980s. Bacteriological cure rates observed in these trials were consistently >85%, and studies of different dosing regimens suggested that a 3 day course was appropriate. Comparative studies reported that pivmecillinam was equivalent to other antimicrobial agents in terms of clinical and bacteriological outcomes. These studies also documented that pivmecillinam was effective for treatment of Staphylococcus saprophyticus infections, was acceptable for use in pregnancy and was well tolerated. Subsequent widespread use of pivmecillinam in Scandinavian countries has led to a body of clinical experience which confirms the efficacy and safety of this antimicrobial agent in the treatment of acute cystitis. Recently, two large, prospective, randomized, double-blind, multi-centre clinical trials have been completed to assist in defining the role of this antimicrobial agent in the treatment of acute cystitis. A comparison of 3 day courses of pivmecillinam or norfloxacin, both at 400 mg bd, showed higher bacteriological cure rates with norfloxacin but generally similar clinical outcomes. A second, dose-ranging study found that pivmecillinam, given bd for 7 days, led to superior bacteriological and clinical outcomes at short-term follow-up than the 3 day regimen. Pooling bacteriological outcomes from the two studies showed similar outcomes with 7 days of pivmecillinam 200 mg bd or 3 days of norfloxacin 400 mg bd. The shorter, 3 day, course achieved similar short-term clinical outcomes to 7 days of pivmecillinam and 3 days of norfloxacin in women aged < or =50 years. These recent studies confirm earlier reports and clinical experience that pivmecillinam is effective and well tolerated for the treatment of acute cystitis in women.

Amoxicillin-Clavulanate vs Ciprofloxacin for the Treatment of Uncomplicated Cystitis in Women: A Randomized Trial

Amoxicillin-Clavulanate vs Ciprofloxacin for the Treatment of Uncomplicated Cystitis in Women: A Randomized Trial

Amoxicillin-Clavulanate vs Ciprofloxacin for the Treatment of Uncomplicated Cystitis in Women: A Randomized Trial

Amoxicillin-Clavulanate vs Ciprofloxacin for the Treatment of Uncomplicated Cystitis in Women: A Randomized Trial

Amoxicillin/clavulanate for the treatment of uncomplicated cystitis in women: a historical perspective

Amoxicillin/clavulanate for the treatment of uncomplicated cystitis in women: a historical perspective

Amoxicillin-Clavulanate Versus Ciprofloxacin for the Treatment of Uncomplicated Cystitis in Women: A Randomized Trial

Amoxicillin-Clavulanate Versus Ciprofloxacin for the Treatment of Uncomplicated Cystitis in Women: A Randomized Trial

ALRAEK AND BAERHEIM RESPOND

Katz raises important issues, which need to be considered in further studies on acupuncture and recurrent cystitis. Our answers will, hopefully, further elucidate some of these points. The subjects in our study were asked to seek medical aid in case of acute symptoms of cystitis. If a doctor was not available, patients were instructed to culture a preaddressed dip-slide and mail it to the laboratory for bacteriological examination. Having provided urine for culture, the patients could start medical treatment or not, according to preference. Norwegian doctors normally prescribe a 3- to 5-day course of antibiotics for acute cystitis. None of the patients were put on more prolonged courses or continuous antibiotic prophylaxis during the study. Nor were they allowed to use cranberries for prophylaxis. We have no information on type of antibiotic used, as this decision was the responsibility of each patient’s family doctor. To our knowledge differences in treatment strategies for acute, uncomplicated cystitis in otherwise healthy women do not correlate to their further prognosis with regard to cystitis. We agree with Katz that further studies in complementary and alternative medicine should focus on biological plausibility of the findings as a key issue. As far as we know, our study is the first acupuncture study to focus on the relationship between recurrent cystitis and residual urine. These findings are in general relevant for understanding the pathogenesis of recurrent cystitis. In our most recent study,1 we also performed urodynamic studies and measurement of the vagal and adrenergic tone. However, these parameters did not indicate further explanations regarding the treatment effect. The American Food and Drug Administration has recommended acupuncture (stimulation of the P6 acupuncture point) as an antiemetic treatment. This recommendation is partly due to systematic reviews and meta-analysis concluding clinically significant results,2,3 but still the actual explanation for the effect is lacking. To clarify, residual urine was not incorporated as a parameter in our earlier study.4 Patients who became pregnant in our study were taken out of the study at the time the pregnancy was diagnosed. Cystitis occurring in pregnant women is by definition no longer uncomplicated5 and should of course be treated accordingly. At this stage it is too early for final conclusions, but we hope that other researchers can duplicate our results. This will add to evidence for the use of acupuncture as prophylactic treatment for recurrent cystitis in women of reproductive age.

Three-day trimethoprim-sulfamethoxazole was best for acute cystitis

Source Citation Hooton TM, Winter C, Tiu F, Stamm WE. Randomized comparative trial and cost analysis of 3-day antimicrobial regimens for treatment of acute cystitis in women. JAMA. 1995 Jan 4;273:41-5.

Efficacy of Single-Dose versus Seven-Day Trimethoprim Treatment of Cystitis in Women: A Randomized Double-Blind Study

Single-dose trimethoprim treatment of cystitis was compared with 7-day treatment in a randomized double-blind study in primary health care. Consecutive female patients (613) with symptoms of lower urinary tract infection (UTI) and positive bacteriuria screening tests were enrolled. In 502 cases UTI was confirmed by urine culture. Follow-up was performed twice, after 2-3 and 5-6 weeks. Short-term efficacy could be evaluated in 425 cases and accumulated efficacy in 344. Short-term efficacy was 82% for single-dose and 94% for 7-day treatment (P less than .001). Accumulated efficacy was 71% for single-dose and 87% for 7-day therapy (P less than .001). Fewer adverse reactions were noted with single-dose therapy (not significant). The cure rate for UTI caused by P-fimbriated Escherichia coli was not different from that of other E. coli infections. Infections with Staphylococcus saprophyticus showed a lower cure rate than E. coli infections with the single-dose regimen (P less than .05 for short-term efficacy).

A general practitioner multicenter study: Fosfomycin trometamol single dose versus pipemidic acid multiple dose

In order to evaluate the efficacy and safety of fosfomycin trometamol as single dose oral treatment for acute cystitis in women, an open, multicenter comparative study was carried out in general practices in France, 386 women, aged 16 to 75 years, with clinical symptoms of acute cystitis were enrolled in the study to receive either a single 3 g oral dose of fosfomycin trometamol or a five-day course of 400 mg pipemidic acid twice daily. The diagnosis of cystitis was based on clinical symptoms and significant bacteriuria (greater than or equal to 10(5) cfu/ml midstream urine). Follow-up examinations were carried out five to ten and 28 days after the end of treatment, 289 and 244 patients, respectively, were available for clinical and bacteriological evaluation at short-term (five to ten days) and medium-term (28 days) post-treatment follow-up. Both regimens were comparable for clinical and bacteriological efficacy with short-term eradication rates of 122/146 in the fosfomycin trometamol group and 130/143 in the pipemidic acid group. The results of medium-term follow-up were 113/122 and 114/122 for the eradication rates of the respective groups. Both drugs were well tolerated. Side effects were mild and of significantly shorter duration in the fosfomycin trometamol group.

Fleroxacin in the treatment of uncomplicated acute cystitis in women.

Twenty-four women with uncomplicated acute lower urinary tract infections proven by significant pretreatment bacteriuria (greater than or equal to 10(5) cfu/ml) were treated with a single oral dose of either 200 or 400 mg fleroxacin. Patients were checked for response to treatment five to nine days post therapy. Of the 24 patients initially included in the study, five were not available for assessment of efficacy. In 17 of the remaining 19 women bacteriological cure was achieved.