What to do in case of cystitis?
In cases of uncomplicated episode, when antibiotics are needed, discuss it with your doctor, to adapt your treatment to local guidelines and antimicrobial resistances.
Discuss with your doctor how to decrease the number of recurrences.
A certain order and hierarchy of recommendations should be followed when planning the prevention strategy: RECAP
1. Identify risk factors
Possible risk factors (reversible and irreversible) for recurrences should be identified in detail.
2. Eliminate risk factors
Reversible risk factors should be eliminated (residual urine, low fluid intake, intrauterine device, use of spermicides etc).
3. Patient education
Patient education about basic microbiological and physiological aspects of the female pelvic microbial ecosystem and rUTIs should be given.
Permits patients to identify individual risk factors, which can be targeted.
Allows patients to feel in control of their disease, which has a significant positive effect on their quality of life.
4. Lifestyle advice & other non-antimicrobial prevention
Lifestyle advice should be given, and non-antibiotic prevention methods should be applied based on the identified individual risk factors.
5. Antibiotic prophylaxis
Antibiotic prophylaxis should be applied as a last resort, when non-antibiotic prevention strategy has failed.
Primary antibiotic prophylaxis is only recommended in severe cases with very frequent recurrence or robust symptoms, leading to severe psychological distress.
Use continuous or post-coital antimicrobial prophylaxis to prevent recurrent UTIs when non-antimicrobial interventions have failed and urine culture is positive. Counsel patients regarding possible side effects.
6. Education on proper self treatment
Patients should be educated about proper self-treatment of each acute cystitis episode. Avoiding unnecessary antibiotics is mandatory.
Apply non-antibiotic prophylaxis as first-line.
The kind of non-antibiotic prophylaxis recommended should follow the rules of evidence based medicine.
Fosfomycin-trometamol, nitrofurantoin, pivmecillinam should be prescribed for treatment if antibiotics are needed.
Here is an example of what is detailed in European recommendations to prevent recurrent cystitis
Current options
Lifestyle modifications
Behavioural risk factors, eg sexual activity and form of contraception
Recommended non-antibiotic prophylaxis
- Immunoactive therapy
- Hormonal replacement (for postmenopausal women)
Other non-antibiotic prophylaxis (not recommended)
- D-Mannose
- Lactobacillus (probiotics)
- Cranberry products
- Ascorbic acid
- Methenamine salts
Antibiotics
- Continuous low dose prophylaxis
- Post-coital prophylaxis
- Patient initiated therapy
RECAP = Where a claim is followed by the RECAP, this means that this claim is endorsed by the RECAP board of experts.
