From the Research
In the case of a patient presenting with cystitis symptoms and a urinalysis showing no bacteria or white blood cells (WBCs), I recommend treating for interstitial cystitis rather than bacterial cystitis, as the absence of bacterial markers suggests a non-infectious cause. The patient's symptoms, such as frequency, urgency, and dysuria, can be managed with phenazopyridine (Pyridium) 200mg three times daily for 2-3 days for symptom relief, along with over-the-counter NSAIDs like ibuprofen 400-600mg every 6-8 hours as needed for pain and inflammation 1. Increasing fluid intake to help flush the urinary system and avoiding bladder irritants such as caffeine, alcohol, spicy foods, and acidic beverages can also help alleviate symptoms. If symptoms persist beyond 3-5 days, follow-up with a primary care provider or urologist for further evaluation is recommended. It is essential to note that the provided evidence, including studies from 2, 3, 4, and 5, primarily focuses on the treatment of bacterial urinary tract infections, which may not be applicable in this case due to the absence of bacteria and WBCs in the urinalysis. Therefore, the recommended treatment approach prioritizes symptom management and avoids unnecessary antibiotics, which would be ineffective without bacterial presence. Key considerations in this approach include:
- Symptom management with phenazopyridine and NSAIDs
- Increased fluid intake and avoidance of bladder irritants
- Follow-up evaluation if symptoms persist
- Avoidance of unnecessary antibiotics in the absence of bacterial markers.