Cystitis: Difference between revisions

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* Cleaning the urethral [[meatus]] (the opening of the [[urethra]]) after [[sexual intercourse|intercourse]] has been shown to be of some benefit; however, whether this is done with an [[antiseptic]] or a [[placebo]] ointment (an ointment containing no active ingredient) does not appear to matter.<ref name=meyhoff>{{cite journal | author = Meyhoff H, Nordling J, Gammelgaard P, Vejlsgaard R | title = Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis? | journal = Scand J Urol Nephrol | volume = 15 | issue = 2 | pages = 81-3 | year = 1981 | id = PMID 7036332}}</ref>
* Cleaning the urethral [[meatus]] (the opening of the [[urethra]]) after [[sexual intercourse|intercourse]] has been shown to be of some benefit; however, whether this is done with an [[antiseptic]] or a [[placebo]] ointment (an ointment containing no active ingredient) does not appear to matter.<ref name=meyhoff>{{cite journal | author = Meyhoff H, Nordling J, Gammelgaard P, Vejlsgaard R | title = Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis? | journal = Scand J Urol Nephrol | volume = 15 | issue = 2 | pages = 81-3 | year = 1981 | id = PMID 7036332}}</ref>
* [[Cranberry]] juice may decrease the incidence of cystitis according to a [[systematic review]] of [[randomized controlled trial]]s by the [[Cochrane Collaboration]]. The Cochrane concluded 'some evidence from trials to show cranberries (juice and capsules) can prevent recurrent infections in women. Many people in the trials stopped drinking the juice, suggesting it may not be a popular intervention'.<ref name=jepson>{{cite journal | author = Jepson R, Mihaljevic L, Craig J | title = Cranberries for preventing urinary tract infections. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD001321 | year = | id = PMID 14973968}}</ref>
* [[Cranberry]] juice may decrease the incidence of cystitis according to a [[systematic review]] of [[randomized controlled trial]]s by the [[Cochrane Collaboration]]. The Cochrane concluded 'some evidence from trials to show cranberries (juice and capsules) can prevent recurrent infections in women. Many people in the trials stopped drinking the juice, suggesting it may not be a popular intervention'.<ref name=jepson>{{cite journal | author = Jepson R, Mihaljevic L, Craig J | title = Cranberries for preventing urinary tract infections. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD001321 | year = | id = PMID 14973968}}</ref>
* Continuous antibiotic prophylaxis may be beneficial according to [[randomized controlled trial]]s<ref name="pmid12766829">{{cite journal |author=Raz R, Colodner R, Rohana Y, ''et al'' |title=Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women |journal=Clin. Infect. Dis. |volume=36 |issue=11 |pages=1362–8 |year=2003 |month=June |pmid=12766829 |doi=10.1086/374341 |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID30441 |issn=}}</ref> and a meta-analysis by the [[Cochrane Collaboration]]<ref name="pmid15266443">{{cite journal |author=Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C |title=Antibiotics for preventing recurrent urinary tract infection in non-pregnant women |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD001209 |year=2004 |pmid=15266443 |doi=10.1002/14651858.CD001209.pub2 |url=http://dx.doi.org/10.1002/14651858.CD001209.pub2 |issn=}}</ref>.
* Continuous antibiotic prophylaxis may be beneficial according to [[randomized controlled trial]]s<ref name="pmid12766829">{{cite journal |author=Raz R, Colodner R, Rohana Y, ''et al'' |title=Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women |journal=Clin. Infect. Dis. |volume=36 |issue=11 |pages=1362–8 |year=2003 |month=June |pmid=12766829 |doi=10.1086/374341 |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID30441 |issn=}}</ref> and a meta-analysis by the [[Cochrane Collaboration]]<ref name="pmid15266443">{{cite journal |author=Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C |title=Antibiotics for preventing recurrent urinary tract infection in non-pregnant women |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD001209 |year=2004 |pmid=15266443 |doi=10.1002/14651858.CD001209.pub2 |url=http://dx.doi.org/10.1002/14651858.CD001209.pub2 |issn=}}</ref>. Nitrofurantion may<ref name="pmid4044461">{{cite journal |author=Brumfitt W, Smith GW, Hamilton-Miller JM, Gargan RA |title=A clinical comparison between Macrodantin and trimethoprim for prophylaxis in women with recurrent urinary infections |journal=J. Antimicrob. Chemother. |volume=16 |issue=1 |pages=111–20 |year=1985 |month=July |pmid=4044461 |doi= |url=http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=4044461 |issn=}}</ref> or may not<ref name="pmid6992677">{{cite journal |author=Stamm WE, Counts GW, Wagner KF, ''et al'' |title=Antimicrobial prophylaxis of recurrent urinary tract infections: a double-blind, placebo-controlled trial |journal=Ann. Intern. Med. |volume=92 |issue=6 |pages=770–5 |year=1980 |month=June |pmid=6992677 |doi= |url= |issn=}}</ref> be more effective than trimethoprim monotherapy.
* For post-menopausal women, a [[randomized controlled trial]]<ref name="pmid8350884">{{cite journal | author = Raz R, Stamm W | title = A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. | journal = N Engl J Med | volume = 329 | issue = 11 | pages = 753-6 | year = 1993 | id = PMID 8350884|url=http://content.nejm.org/cgi/content/full/329/11/753|doi=10.1056/NEJM199309093291102}}</ref> and a meta-analysis<ref name="pmid18425910">{{cite journal |author=Perrotta C, Aznar M, Mejia R, Albert X, Ng CW |title=Oestrogens for preventing recurrent urinary tract infection in postmenopausal women |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD005131 |year=2008 |pmid=18425910 |doi=10.1002/14651858.CD005131.pub2 |url=http://dx.doi.org/10.1002/14651858.CD005131.pub2 |issn=}}</ref> by the [[Cochrane Collaboration]] has shown that intravaginal  [[estrogen]] cream can prevent recurrent cystitis. In the original trial in 1993, patients in the experimental group applied 0.5 mg of estriol vaginal cream nightly for two weeks followed by twice-weekly applications for eight months<ref name="pmid8350884"/>.  
* For post-menopausal women, a [[randomized controlled trial]]<ref name="pmid8350884">{{cite journal | author = Raz R, Stamm W | title = A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. | journal = N Engl J Med | volume = 329 | issue = 11 | pages = 753-6 | year = 1993 | id = PMID 8350884|url=http://content.nejm.org/cgi/content/full/329/11/753|doi=10.1056/NEJM199309093291102}}</ref> and a meta-analysis<ref name="pmid18425910">{{cite journal |author=Perrotta C, Aznar M, Mejia R, Albert X, Ng CW |title=Oestrogens for preventing recurrent urinary tract infection in postmenopausal women |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD005131 |year=2008 |pmid=18425910 |doi=10.1002/14651858.CD005131.pub2 |url=http://dx.doi.org/10.1002/14651858.CD005131.pub2 |issn=}}</ref> by the [[Cochrane Collaboration]] has shown that intravaginal  [[estrogen]] cream can prevent recurrent cystitis. In the original trial in 1993, patients in the experimental group applied 0.5 mg of estriol vaginal cream nightly for two weeks followed by twice-weekly applications for eight months<ref name="pmid8350884"/>.  
** Higher dose of intravaginal estrogen cream (1 mg estriol daily for two weeks then twice a week for two additional weeks) may help premenopausal women for 11 months.<ref name="pmid15661421">{{cite journal |author=Pinggera GM, Feuchtner G, Frauscher F, ''et al'' |title=Effects of local estrogen therapy on recurrent urinary tract infections in young females under oral contraceptives |journal=Eur. Urol. |volume=47 |issue=2 |pages=243–9 |year=2005 |month=February |pmid=15661421 |doi=10.1016/j.eururo.2004.09.008 |url=http://linkinghub.elsevier.com/retrieve/pii/S0302-2838(04)00482-8 |issn=}}</ref> However, this study was uncontrolled.
** Higher dose of intravaginal estrogen cream (1 mg estriol daily for two weeks then twice a week for two additional weeks) may help premenopausal women for 11 months.<ref name="pmid15661421">{{cite journal |author=Pinggera GM, Feuchtner G, Frauscher F, ''et al'' |title=Effects of local estrogen therapy on recurrent urinary tract infections in young females under oral contraceptives |journal=Eur. Urol. |volume=47 |issue=2 |pages=243–9 |year=2005 |month=February |pmid=15661421 |doi=10.1016/j.eururo.2004.09.008 |url=http://linkinghub.elsevier.com/retrieve/pii/S0302-2838(04)00482-8 |issn=}}</ref> However, this study was uncontrolled.

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In medicine, cystitis is a form of urinary tract infection characterized by "inflammation of the urinary bladder, either from bacterial or non-bacterial causes. Cystitis is usually associated with painful urination (dysuria), increased frequency, urgency, and suprapubic pain."[1]

Diagnosis

A clinical prediction rule suggests that if a patient has at least two of 1) dysuria, 2) the presence of more than trace leukocytes, 3) or the presence of nitrites, the diagnosis is sufficiently likely to consider empirical treatment.[2]

Treatment

For uncomplicated cystitis, nitrofurantoin 100 mg by mouth twice a day for 5 days may be used.[3]

Prevention

Selected randomized controlled trials of prevention of urinary tract infection
Author, year Duration of study Rates of recurrence
Raz, 1993[4] 8 months Intravaginal estrogen cream:
25%		 Placebo:
65%
Eriksen, 1999[5] 9 months Intravaginal estrogen via vaginal ring:
55%		 No treatment:
80%
Raz, 2003[6] 9 months Intravaginal estrogen via pessary:
67%		 Nitrofurantion:
52%

The following are measures that studies suggest may reduce the incidence of urinary tract infections. These may be appropriate for people, especially women, with recurrent infections:

  • Cleaning the urethral meatus (the opening of the urethra) after intercourse has been shown to be of some benefit; however, whether this is done with an antiseptic or a placebo ointment (an ointment containing no active ingredient) does not appear to matter.[7]
  • Cranberry juice may decrease the incidence of cystitis according to a systematic review of randomized controlled trials by the Cochrane Collaboration. The Cochrane concluded 'some evidence from trials to show cranberries (juice and capsules) can prevent recurrent infections in women. Many people in the trials stopped drinking the juice, suggesting it may not be a popular intervention'.[8]
  • Continuous antibiotic prophylaxis may be beneficial according to randomized controlled trials[6] and a meta-analysis by the Cochrane Collaboration[9]. Nitrofurantion may[10] or may not[11] be more effective than trimethoprim monotherapy.
  • For post-menopausal women, a randomized controlled trial[4] and a meta-analysis[12] by the Cochrane Collaboration has shown that intravaginal estrogen cream can prevent recurrent cystitis. In the original trial in 1993, patients in the experimental group applied 0.5 mg of estriol vaginal cream nightly for two weeks followed by twice-weekly applications for eight months[4].
    • Higher dose of intravaginal estrogen cream (1 mg estriol daily for two weeks then twice a week for two additional weeks) may help premenopausal women for 11 months.[13] However, this study was uncontrolled.
    • Intravaginal estrogen via estriol pessary may not be effective.[6]
    • Intravaginal estrogen may be more effective than continuous oral antibiotics[14]. However, this is not true of the estrogen pessary due to inability to restore normal lactobacilli and lower vaginal pH.[6]

References

  1. ↑ National Library of Medicine. Cystitis. Retrieved on 2007-11-13.
  2. ↑ McIsaac WJ, Moineddin R, Ross S (2007). "Validation of a decision aid to assist physicians in reducing unnecessary antibiotic drug use for acute cystitis". Arch. Intern. Med. 167 (20): 2201–6. DOI:10.1001/archinte.167.20.2201. PMID 17998492. Research Blogging.
  3. ↑ Gupta K, Hooton TM, Roberts PL, Stamm WE (2007). "Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women". Arch. Intern. Med. 167 (20): 2207–12. DOI:10.1001/archinte.167.20.2207. PMID 17998493. Research Blogging.
  4. ↑ 4.0 4.1 4.2 Raz R, Stamm W (1993). "A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections.". N Engl J Med 329 (11): 753-6. DOI:10.1056/NEJM199309093291102. PMID 8350884. Research Blogging.
  5. ↑ Eriksen B (May 1999). "A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women". Am. J. Obstet. Gynecol. 180 (5): 1072–9. PMID 10329858. [e]
  6. ↑ 6.0 6.1 6.2 6.3 Raz R, Colodner R, Rohana Y, et al (June 2003). "Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women". Clin. Infect. Dis. 36 (11): 1362–8. DOI:10.1086/374341. PMID 12766829. Research Blogging.
  7. ↑ Meyhoff H, Nordling J, Gammelgaard P, Vejlsgaard R (1981). "Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis?". Scand J Urol Nephrol 15 (2): 81-3. PMID 7036332.
  8. ↑ Jepson R, Mihaljevic L, Craig J. "Cranberries for preventing urinary tract infections.". Cochrane Database Syst Rev: CD001321. PMID 14973968.
  9. ↑ Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C (2004). "Antibiotics for preventing recurrent urinary tract infection in non-pregnant women". Cochrane Database Syst Rev (3): CD001209. DOI:10.1002/14651858.CD001209.pub2. PMID 15266443. Research Blogging.
  10. ↑ Brumfitt W, Smith GW, Hamilton-Miller JM, Gargan RA (July 1985). "A clinical comparison between Macrodantin and trimethoprim for prophylaxis in women with recurrent urinary infections". J. Antimicrob. Chemother. 16 (1): 111–20. PMID 4044461. [e]
  11. ↑ Stamm WE, Counts GW, Wagner KF, et al (June 1980). "Antimicrobial prophylaxis of recurrent urinary tract infections: a double-blind, placebo-controlled trial". Ann. Intern. Med. 92 (6): 770–5. PMID 6992677. [e]
  12. ↑ Perrotta C, Aznar M, Mejia R, Albert X, Ng CW (2008). "Oestrogens for preventing recurrent urinary tract infection in postmenopausal women". Cochrane Database Syst Rev (2): CD005131. DOI:10.1002/14651858.CD005131.pub2. PMID 18425910. Research Blogging.
  13. ↑ Pinggera GM, Feuchtner G, Frauscher F, et al (February 2005). "Effects of local estrogen therapy on recurrent urinary tract infections in young females under oral contraceptives". Eur. Urol. 47 (2): 243–9. DOI:10.1016/j.eururo.2004.09.008. PMID 15661421. Research Blogging.
  14. ↑ Xu R, Wu Y, Hu Y (September 2001). "[Prevention and treatment of recurrent urinary system infection with estrogen cream in postmenopausal women]" (in Chinese). Zhonghua Fu Chan Ke Za Zhi 36 (9): 531–3. PMID 11769665. [e]
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