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=" | * 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>. | ||
* For post-menopausal women, a [[randomized controlled trial]] | * 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 Collabroation]] has shown that intravaginal application of topical [[estrogen]] cream can prevent recurrent cystitis. In this original study, 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"/>. Intravaginal estrogen may be more<ref name="pmid11769665">{{cite journal |author=Xu R, Wu Y, Hu Y |title=[Prevention and treatment of recurrent urinary system infection with estrogen cream in postmenopausal women] |language=Chinese |journal=Zhonghua Fu Chan Ke Za Zhi |volume=36 |issue=9 |pages=531–3 |year=2001 |month=September |pmid=11769665 |doi= |url= |issn=}}</ref> or less<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> effective than oral antibiotics. | ||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 12:10, 5 January 2009
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
| Author, year | Duration of study | Rates of recurrence | |
|---|---|---|---|
| Raz, 1993[4] | 8 months | Intravaginal estrogen: 25% |
Placebo: 65% |
| Eriksen, 1999 | 9 months | Intravaginal estrogen: 55% |
No treatment: 80% |
| Raz, 2003[5] | 9 months | Intravaginal estrogen: 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.[6]
- 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'.[7]
- Continuous antibiotic prophylaxis may be beneficial according to randomized controlled trials[5] and a meta-analysis by the Cochrane Collaboration[8].
- For post-menopausal women, a randomized controlled trial[4] and a meta-analysis[9] by the Cochrane Collabroation has shown that intravaginal application of topical estrogen cream can prevent recurrent cystitis. In this original study, 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]. Intravaginal estrogen may be more[10] or less[5] effective than oral antibiotics.
References
- ↑ National Library of Medicine. Cystitis. Retrieved on 2007-11-13.
- ↑ 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.
- ↑ 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.
- ↑ 4.0 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.
- ↑ 5.0 5.1 5.2 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.
- ↑ 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.
- ↑ Jepson R, Mihaljevic L, Craig J. "Cranberries for preventing urinary tract infections.". Cochrane Database Syst Rev: CD001321. PMID 14973968.
- ↑ 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.
- ↑ 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.
- ↑ 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]