From the Guidelines
For resistant interstitial cystitis (IC) that hasn't responded to first-line treatments, ceftazidime-avibactam 2.5 g IV q8h is recommended as a treatment option, as per the most recent guidelines from 2022 1. This recommendation is based on the treatment of infections due to multidrug-resistant organisms, which is relevant to the context of antibiotic resistance in IC. The use of antibiotics in IC should be approached with caution, as IC is not primarily an infectious condition, and antibiotics can sometimes worsen symptoms by disrupting bladder and gut microbiomes. Before starting antibiotics, a urine culture should be performed to confirm infection, and the primary management of IC typically involves multimodal therapy, including:
- Bladder instillations
- Oral medications targeting nerve pain (like amitriptyline or gabapentin)
- Dietary modifications
- Pelvic floor physical therapy Antibiotics should be reserved for cases with clear evidence of infection or as part of a comprehensive treatment plan under specialist guidance. It's also important to note that other antibiotic options, such as meropenem-vaborbactam or plazomicin, may be considered based on the specific circumstances of the patient and the susceptibility of the infecting organism, as outlined in the guidelines 1.
From the Research
Interstitial Cystitis Treatment
- Interstitial cystitis (IC) is a chronic disease characterized by bladder pain, urgency, and frequency, with no single microbe implicated as a cause 2.
- The diagnosis of IC is often one of exclusion, and treatment can be initiated based on symptoms alone 3.
- Oral treatments for IC include pentosan polysulfate, tricyclic antidepressants, and antihistamines, while intravesical therapies include hydrodistention, dimethyl sulfoxide, and heparin 4, 3.
Antibiotic Resistance
- Antibiotic-resistant Gram-negative bacteria are a growing concern in the treatment of urinary tract infections (UTIs) 5.
- High rates of resistance to trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities 5.
- Recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis includes nitrofurantoin, fosfomycin tromethamine, or pivmecillinam 5.
Effective Antibiotics for IC with Antibiotic Resistance
- A pilot study found that sequential oral antibiotics, including rifampin, doxycycline, erythromycin, metronidazole, clindamycin, amoxicillin, and ciprofloxacin, may be associated with decreased symptoms in some patients with IC 2.
- However, the study noted that these antibiotics do not represent a major advance in therapy for IC 2.
- For UTIs caused by antibiotic-resistant bacteria, treatment options include nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, and carbapenems 5.
- It is essential to use new antimicrobials wisely to avoid resistance development 5.