Cystitis: Difference between revisions
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|+ Selected randomized controlled trials of intravaginal estrogen for the prevention of urinary tract infection | |+ Selected randomized controlled trials of intravaginal estrogen for the prevention of urinary tract infection | ||
! Author, year!!Duration of study!! colspan="2"|Rates of recurrence | ! Author, year!!Duration of study!! change in pH in treatment group!!colspan="2"|Rates of recurrence | ||
|- | |- | ||
| Raz, 1993<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>||8 months||Intravaginal [[estrogen]] cream:<br/><center>16%</center>||Placebo:<br/><center>63%</center> | | Raz, 1993<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>||5.5 to 3.6||8 months||Intravaginal [[estrogen]] cream:<br/><center>16%</center>||Placebo:<br/><center>63%</center> | ||
|- | |- | ||
| Eriksen, 1999<ref name="pmid10329858">{{cite journal |author=Eriksen B |title=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 |journal=Am. J. Obstet. Gynecol. |volume=180 |issue=5 |pages=1072–9 |year=1999 |month=May |pmid=10329858 |doi= |url= |issn=}}</ref>||9 months||Intravaginal [[estrogen]] via vaginal ring:<br/><center>55%</center>||No treatment:<br/><center>80%</center> | | Eriksen, 1999<ref name="pmid10329858">{{cite journal |author=Eriksen B |title=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 |journal=Am. J. Obstet. Gynecol. |volume=180 |issue=5 |pages=1072–9 |year=1999 |month=May |pmid=10329858 |doi= |url= |issn=}}</ref>||9 months||6.7 to 5.3||Intravaginal [[estrogen]] via vaginal ring:<br/><center>55%</center>||No treatment:<br/><center>80%</center> | ||
|- | |- | ||
| Raz, 2003<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>|| 9 months||Intravaginal [[estrogen]] via pessary:<br/><center>67%</center>||[[Nitrofurantoin]]:<br/><center>52%</center> | | Raz, 2003<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>|| 9 months||5.6 to 5.3||Intravaginal [[estrogen]] via pessary:<br/><center>67%</center>||[[Nitrofurantoin]]:<br/><center>52%</center> | ||
|} | |} | ||
* 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. The [[relative risk]] of recurrence was 0.25<ref name="pmid8350884"/> to 0.64<ref name="pmid10329858"/> in the two trials included in the review. 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. The [[relative risk]] of recurrence was 0.25<ref name="pmid8350884"/> to 0.64<ref name="pmid10329858"/> in the two trials included in the review. 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"/>. | ||
Revision as of 11:14, 9 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
| Intervention | Number of trials | Relative risk ratio |
|---|---|---|
| Antibiotics[4] (Continuous or postcoital) |
10 | 0.21 |
| Intravaginal estrogen[5] | 2 | 0.25 to 0.64 |
| Cranberry[6] | 10 | 0.65 |
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 relative risk of recurrence was 0.65 and the Cochrane concluded that cranberry 'juice may decrease the number of symptomatic UTIs ...large number of dropouts/withdrawals indicates that cranberry juice may not be acceptable over long periods of time'.[6]
- Continuous antibiotic prophylaxis may decrease the incidence of cystitis according to a systematic review of randomized controlled trials by the Cochrane Collaboration.[4] The relative risk of recurrence was 0.21. Nitrofurantoin may[8] or may not[9] be more effective than trimethoprim monotherapy.
- Postcoital antibiotics may be effective randomized controlled trial.[10][4]
| Author, year | Duration of study | change in pH in treatment group | Rates of recurrence | |
|---|---|---|---|---|
| Raz, 1993[11] | 5.5 to 3.6 | 8 months | Intravaginal estrogen cream: |
Placebo: |
| Eriksen, 1999[12] | 9 months | 6.7 to 5.3 | Intravaginal estrogen via vaginal ring: |
No treatment: |
| Raz, 2003[13] | 9 months | 5.6 to 5.3 | Intravaginal estrogen via pessary: |
Nitrofurantoin: |
- For post-menopausal women, a randomized controlled trial[11] and a meta-analysis[5] by the Cochrane Collaboration has shown that intravaginal estrogen cream can prevent recurrent cystitis. The relative risk of recurrence was 0.25[11] to 0.64[12] in the two trials included in the review. 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[11].
- 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.[14] However, this study was uncontrolled.
- Intravaginal estrogen via estriol pessary may not be effective.[13]
- Intravaginal estrogen may be more effective than continuous oral antibiotics[15]. However, this is not true of the estrogen pessary due to inability to restore normal lactobacilli and lower vaginal pH.[13]
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 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.
- ↑ 5.0 5.1 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.
- ↑ 6.0 6.1 Jepson RG, Craig JC (2008). "Cranberries for preventing urinary tract infections". Cochrane Database Syst Rev (1): CD001321. DOI:10.1002/14651858.CD001321.pub4. PMID 18253990. 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.
- ↑ 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]
- ↑ 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]
- ↑ Stapleton A, Latham RH, Johnson C, Stamm WE (August 1990). "Postcoital antimicrobial prophylaxis for recurrent urinary tract infection. A randomized, double-blind, placebo-controlled trial". JAMA 264 (6): 703–6. PMID 2197450. [e]
- ↑ 11.0 11.1 11.2 11.3 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.
- ↑ 12.0 12.1 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]
- ↑ 13.0 13.1 13.2 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.
- ↑ 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.
- ↑ 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]