Cystitis prevention: Difference between revisions

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{{CMG}} {{AE}} {{YD}}
 
==Overview==
{{CMG}}; {{SCC}} {{AE}}{{AK}}
Preventative measures to avoid cystitis include abstinence from sexual activity, voiding after intercourse, use of barrier contraception during sexual intercourse, increasing fluid intake and frequency of urination, and use of [[estrogen]] (among post-menopausal women). Single-dose prophylactic antimicrobial therapy prior to sexual intercourse may be administered to patients who have recurrent episodes of cystitis that are associated with sexual activity.
==Prevention==
 
===Non-antimicrobial approach===
*Though it is difficult to apply, but abstinence or reduce frequency of sexual intercourse (which is the strongest risk factor for UTI)is a good method to reduce the risk of infection.
*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.
*Using contraception methods other than spermicides especially with diaphragm or spermicide-coated condoms, because they alter normal vaginal flora allowing pathogens to colonize.
*Topical estrogen for postmenopausal women maintains normal vaginal flora and reduces risk of UTIs.<ref name="Raz-1993">{{Cite journal  | last1 = Raz | first1 = R. | last2 = Stamm | first2 = WE. | 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 | month = Sep | year = 1993 | doi = 10.1056/NEJM199309093291102 | PMID = 8350884 }}</ref>
*Cranberry juice, capsules or tablets:although it inhibits uropathogen from adherence to uroepithelial cells, but studies revealed no benefit from using cranberry juice.<ref name="Jepson-2012">{{Cite journal  | last1 = Jepson | first1 = RG. | last2 = Williams | first2 = G. | last3 = Craig |first3 = JC. | title = Cranberries for preventing urinary tract infections. | journal = Cochrane Database Syst Rev | volume = 10 | issue =  | pages = CD001321 | month =  | year = 2012 | doi = 10.1002/14651858.CD001321.pub5 | PMID = 23076891 }}</ref><ref name="Barbosa-Cesnik-2011">{{Cite journal  |last1 = Barbosa-Cesnik | first1 = C. | last2 = Brown | first2 = MB. | last3 = Buxton | first3 = M. | last4 = Zhang | first4 = L. | last5 = DeBusscher| first5 = J. | last6 = Foxman | first6 = B. | title = Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. | journal = Clin Infect Dis | volume = 52 | issue = 1 | pages = 23-30 | month = Jan | year = 2011 | doi = 10.1093/cid/ciq073 | PMID = 21148516 }}</ref>
*D-mannose theoretically inhibits [[E.Coli=]] adherence to oruepithelium, but no studies support the benefit or effectiveness..<ref>{{Cite journal  |last1 = Hooton | first1 = TM. | title = Clinical practice. Uncomplicated urinary tract infection. | journal = N Engl J Med | volume = 366 | issue = 11 | pages = 1028-37 | month = Mar | year = 2012 |doi = 10.1056/NEJMcp1104429 | PMID = 22417256 }}</ref>
 
===Antimicrobials approach===
*As treatment ,choosing the appropriate antimicrobial should depend on patient allergy and susceptibility of the causative organism. 
*'''Self-diagnosis and self treatment:''' for women with previous infection that can self-diagnose a subsequent cystitis are advised to start first line regimen at the onset of urinary symptoms.85-95% accuracy of diagnosis with no clinic visit needed so it has better satisfaction.
*'''Antimicrobial prophylaxis'''
Postcoital regimen is used when coitus related UTI is suspected.
{|
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{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: center; width:25em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Postcoital prophylaxis}}''
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Single dose''
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left |  ▸ '''''[[Nitrofurantoin]] 50-100 mg PO  <br>▸[[TMP-SMX]] 40/200 mg or 80/400 mg PO.<br>▸[[TMP]]  100 mg PO.<br>▸[[Cephalexin]]  250 mg PO.'''''
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|}
|}
*Urine culture should be done to confirm absence of bacteriuria.
{|
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{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: center; width:25em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Continuous prophylaxis}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Bed time daily dose except [[Fosfomycin]]''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left |  ▸ '''''[[Nitrofurantoin]] 50-100 mg PO. <br>▸[[TMP-SMX]] 40/200 mg PO.<br>▸[[TMP]]  100 mg PO.<br>▸[[Cephalexin]]  250 mg PO.<br>▸[[Fosfomycin]] 3 g every 10 days.'''''
|-
|}
|}
 
 
 
 
 


==Primary Prevention==
The following preventative measures may reduce the risk of cystitis:
<ref name="Raz-1993">{{Cite journal  | last1 = Raz | first1 = R. | last2 = Stamm | first2 = WE. | 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 | month = Sep | year = 1993 | doi = 10.1056/NEJM199309093291102 | PMID = 8350884 }}</ref>
*Abstinence from sexual activity
*Voiding after every intercourse
*Use barrier contraception and avoiding spermicides
*Increasing the intake of fluids and the frequency of urination
*Use of topical estrogen among post-menopausal women


The use of cranberry to prevent cystitis remains controversial. Cranberry is thought to prevent the adherence of uropathogens to urothelial cells, but its benefit is yet to be proven.<ref>{{Cite journal  |last1 = Hooton | first1 = TM. | title = Clinical practice. Uncomplicated urinary tract infection. | journal = N Engl J Med | volume = 366 | issue = 11 | pages = 1028-37 | month = Mar | year = 2012 |doi = 10.1056/NEJMcp1104429 | PMID = 22417256 }}</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 13:43, 16 January 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.

Overview

Preventative measures to avoid cystitis include abstinence from sexual activity, voiding after intercourse, use of barrier contraception during sexual intercourse, increasing fluid intake and frequency of urination, and use of estrogen (among post-menopausal women). Single-dose prophylactic antimicrobial therapy prior to sexual intercourse may be administered to patients who have recurrent episodes of cystitis that are associated with sexual activity.

Primary Prevention

The following preventative measures may reduce the risk of cystitis: [1]

  • Abstinence from sexual activity
  • Voiding after every intercourse
  • Use barrier contraception and avoiding spermicides
  • Increasing the intake of fluids and the frequency of urination
  • Use of topical estrogen among post-menopausal women

The use of cranberry to prevent cystitis remains controversial. Cranberry is thought to prevent the adherence of uropathogens to urothelial cells, but its benefit is yet to be proven.[2]

References

  1. ↑ Raz, R.; Stamm, WE. (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. Unknown parameter |month= ignored (help)
  2. ↑ 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 |month= ignored (help)


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