Treating Uncomplicated Cystitis

Kiran Panesar, BPharmS (Hons), MRPharmS, RPh, CPh

Disclosures

US Pharmacist. 2013;38(8):34-37. 

In This Article

Preventive Strategies

A number of preventive strategies are available to patients, although the use of some is not well established. Various behavioral strategies may also be useful in some cases of recurring cystitis (Table 3).[2,13]

Cranberry juice has been used for many years in the prevention of cystitis, although a Cochrane review found no evidence to support its use for this purpose.[26] The recommended dosage is 16 oz of unsweetened juice daily or 500 mg of cranberry extract twice daily.[13]

Topical estrogen can be used to normalize the vaginal flora, particularly in postmenopausal women; oral estrogens are not effective in this regard.[27] Application of 0.5 mg estriol vaginally every night for 2 weeks, followed by twice weekly administration, is recommended.[13]

Adhesion blockers such as D-mannose may prove useful in preventing the adhesion of bacteria to mannosylated receptors in the urothelium. While there are no clinical trials to evaluate these data, dosages of ¾ to 1 teaspoon 3 times daily are thought to be ideal.[2,13]

Methenamine hippurate 1 g taken twice daily has been shown to be effective for preventing cystitis, particularly when used for short-term prophylaxis.[17,28]

In patients who are able to recognize the initial onset of symptoms of cystitis, first-line antimicrobial regimens may be prescribed for the patient to keep at hand.[2] In other cases, a single dose of antimicrobial therapy may be prescribed to use as soon as possible after intercourse. The choice of the agent should be based upon the patient's susceptibility to and history of any drug allergies.[2] Recommended dosages in such cases are listed in Table 4.[2]

Vaccine Development

A vaccine against UPEC is currently under development that may reduce the rates of incidence and recurrence of UTIs.[5] Uromone, available in Spain, is a sublingual bacterial vaccine for the prevention of recurrent UTIs.[29] No information regarding trials on its use in the United States was found.

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