From the Guidelines
Chronic cystitis treatment should prioritize the use of short-course antibiotics, such as nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or fosfomycin as a single dose, as recommended by the American College of Physicians 1.
Treatment Options
- For bacterial cystitis, a course of antibiotics such as trimethoprim-sulfamethoxazole (Bactrim DS, 1 tablet twice daily for 3-7 days), nitrofurantoin (Macrobid, 100mg twice daily for 5-7 days), or ciprofloxacin (Cipro, 250-500mg twice daily for 3-7 days) is the primary treatment.
- For non-bacterial interstitial cystitis, pentosan polysulfate sodium (Elmiron, 100mg three times daily) may be prescribed for long-term use.
Lifestyle Modifications
- Drinking plenty of water (2-3 liters daily) to help flush out bacteria and reduce the risk of recurrence.
- Avoiding bladder irritants such as caffeine, alcohol, spicy foods, and acidic fruits.
- Practicing good hygiene to prevent the spread of infection.
Pain Management
- Applying warm compresses to the lower abdomen to help relieve discomfort.
- Using phenazopyridine (Pyridium, 200mg three times daily for 2 days) or over-the-counter NSAIDs for pain relief.
Recurrent Infections
- Low-dose prophylactic antibiotics or post-intercourse antibiotics may be necessary to prevent recurrence. According to the most recent guidelines, the use of short-course antibiotics is recommended to reduce the risk of antibiotic resistance and minimize side effects 2. Additionally, lifestyle modifications and pain management strategies can help alleviate symptoms and improve quality of life 3.
From the Research
Chronic Cystitis Treatment
- The treatment of chronic cystitis, also known as interstitial cystitis, is challenging due to its complex pathogenesis and lack of effective therapies 4, 5.
- Current treatment options for interstitial cystitis include oral medications such as pentosan polysulfate, tricyclic antidepressants, and antihistamines, as well as intravesical therapies like hydrodistention, dimethyl sulfoxide, and heparin 4, 5.
- For bacterial cystitis, antibiotic therapy is the primary treatment, with recommended first-line antibiotics including nitrofurans and fosfomycin trometamol 6, 7.
- The choice of antibiotic should be based on the level of resistance of uropathogens, primarily Escherichia coli, and the ecological safety of the antimicrobial therapy 7.
- In cases of uncomplicated cystitis, short-course antimicrobial regimens are usually effective, but antimicrobial resistance can complicate treatment choices 8.
Treatment Options
- Oral medications:
- Pentosan polysulfate
- Tricyclic antidepressants
- Antihistamines
- Intravesical therapies:
- Hydrodistention
- Dimethyl sulfoxide
- Heparin
- Antibiotics:
- Nitrofurans
- Fosfomycin trometamol
- Cephalosporins
Considerations
- The diagnosis of interstitial cystitis should be based on patient history, physical examination, and cystoscopy 4, 5.
- The treatment of chronic cystitis should be individualized and may require a combination of therapies 4, 5.
- Antimicrobial resistance is a growing concern in the treatment of bacterial cystitis, and ecological safety should be considered when choosing an antibiotic 7, 8.