Cystitis prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]
Prevention
Keeping the genital area clean and remembering to wipe from front to back may reduce the chance of introducing bacteria from the rectal area to the urethra.
Increasing the intake of fluids may allow frequent urination to flush the bacteria from the bladder. Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during intercourse. Refraining from urinating for long periods of time may allow bacteria time to multiply, so frequent urinating may reduce risk of cystitis in those who are prone to urinary tract infections.
Drinking cranberry juice prevents certain types of bacteria from attaching to the wall of the bladder and may lessen the chance of infection. [1] Cranberry extract tablets have also been found to be effective in preventing cystitis, and avoid the taste of cranberry juice, which some find unpleasant.[2]
Recommend abstinence or reduction in frequency of intercourse Sexual intercourse is the strongest risk factor for uncomplicated UTIs; often this behavioral strategy is not feasible If spermicides are used, recommend changing to another method for contraception or prevention of infection Spermicide use, including use of spermicide-coated condoms, is a strong risk factor, especially if used with a diaphragm; spermicides alter the vaginal flora and favor the colonization of uropathogens Recommend that patient urinate soon after intercourse, drink fluids liberally, not routinely delay urination, wipe front to back after defecation, avoid tight-fitting underwear, avoid douching In case–control studies, none of these strategies have been shown to be associated with a reduced risk of recurrent UTIs, and none have been studied prospectively; however, it is reasonable to suggest them to the patient, since they pose a low risk and might be effective Biologic mediators Cranberry juice, capsules or tablets Biologic plausibility is based on the inhibition of uropathogen adherence to uroepithelial cells; clinical data supporting a protective effect have been limited by design flaws40; a recent randomized, placebo-controlled trial showed no benefit from cranberry juice41 Topical estrogen In some postmenopausal women, topical estrogen normalizes the vaginal flora and reduces the risk of recurrent UTIs42; oral estrogens are not effective Adhesion blockers (D-mannose, available in health-food stores and online, is occasionally used as preventive therapy) UTIs caused by E. coli are initiated by adhesion of the bacteria to mannosylated receptors in the uroepithelium by means of FimH adhesin located on type 1 pili; theoretically, mannosides could block adhesion; however, D-mannose has not been evaluated in clinical trials
Strategy Comments
Self-diagnosis and self-treatment
First-line antimicrobial regimen is prescribed for future use;
patient
is advised to take it at onset of UTI symptoms
This is not a preventive strategy. Women with previously diagnosed cystitis
can accurately self-diagnose subsequent cystitis in more than 85 to 95%
of cases and can successfully treat themselves43; higher patient satisfaction
with this strategy than with traditional visits to provider for UTI
symptoms and less antimicrobial exposure than with continuous antimicrobial
prophylaxis; should be reserved for motivated women with
previous culture-confirmed cystitis who will comply with the treatment
regimen; urine culture should be obtained periodically before treatment
to confirm presence of UTI and drug susceptibilities
Antimicrobial prophylaxis†
Postcoital antimicrobial prophylaxis: single dose of antimicrobial
agent as soon as feasible after intercourse
Nitrofurantoin, 50–100 mg‡
TMP-SMX, 40 mg and 200 mg or 80 mg and 400 mg§
TMP, 100 mg§
Cephalexin, 250 mg‡
In a placebo-controlled trial, the rate of recurrent cystitis with postcoital
TMP-SMX, 40 mg and 200 mg, was 0.3 episodes per patient-year, vs.
3.6 with placebo (a 92% reduction)44; can be used if UTIs are temporally
related to coitus; absence of bacteriuria should first be confirmed by
negative results on urine culture; results in less antimicrobial exposure
than with continuous prophylaxis; fluoroquinolones (e.g., ciprofloxacin,
125 mg) are highly effective but are not recommended§
Continuous antimicrobial prophylaxis: daily bedtime dose
(except fosfomycin; see below)
Nitrofurantoin, 50–100 mg‡
TMP-SMX, 40 mg and 200 mg (3 times weekly is also effective)§
TMP, 100 mg§
Cephalexin, 125–250 mg‡
Fosfomycin, 3-g sachet every 10 days‡45
Randomized, placebo-controlled trials have shown a reduction in cystitis
recurrences of approximately 95%; side effects are common (e.g., rash,
yeast vaginitis); absence of bacteriuria should first be confirmed by negative
results on urine culture; a 6-month trial is recommended, then treatment
is discontinued and the patient observed; about 50% of patients
have a reversion to the previous pattern of recurrences of cystitis24; if recurrences
continue, prophylaxis may be restarted; rare toxic effects of
long-term exposure to nitrofurantoin include pulmonary hypersensitivity,
chronic hepatitis, and peripheral neuropathy; fluoroquinolones (e.g.,
ciprofloxacin, 125 mg) are highly effective but not recommended§; antimicrobial
resistance in colonizing strains or breakthrough infections are
reported in some studies
References
- ↑ Nutrition About.com
- ↑ Hooton, TM. (2012). "Clinical practice. Uncomplicated urinary tract infection". N Engl J Med. 366 (11): 1028–37. doi:10.1056/NEJMcp1104429. PMID 22417256. Unknown parameter
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