From the Guidelines
Cystitis, also known as Interleukin-8 (IL-8) or Cystitis C, is primarily caused by conditions that lead to complicated urinary tract infections (UTIs), including obstruction at any site in the urinary tract, urinary tract infection in males, pregnancy, diabetes mellitus, immunosuppression, and health care–associated infections 1.
Common Causes of Complicated UTIs
The most common causes of complicated UTIs that can lead to cystitis include:
- Obstruction at any site in the urinary tract
- Urinary tract infection in males
- Pregnancy
- Diabetes mellitus
- Immunosuppression
- Health care–associated infections
- Recent history of instrumentation
- ESBL-producing organisms isolated
- Multidrug-resistant organisms isolated
Pathogens Involved
The microbial spectrum of complicated UTIs is greater than for uncomplicated UTIs, and antimicrobial resistance is more likely 1. The most common species found in cultures include:
- E. coli
- Proteus spp.
- Klebsiella spp.
- Pseudomonas spp.
- Serratia spp.
- Enterococcus spp.
Management
Appropriate management of the urological abnormality or the underlying complicating factor is mandatory 1. Optimal antimicrobial therapy for complicated UTIs depends on the severity of the illness at presentation, as well as local resistance patterns and specific host factors.
Treatment Duration
Treatment for 7 to 14 days is generally recommended, but the duration should be closely related to the treatment of the underlying abnormality 1. When the patient is haemodynamically stable and has been afebrile for at least 48 hours, a shorter treatment duration may be considered in cases for which short-course treatment is desirable owing to relative contraindicions to the antibiotic administered 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Instillation of 50 mL of RIMSO-50® (dimethyl sulfoxide) directly into the bladder may be accomplished by catheter or asepto syringe and allow to remain for 15 minutes. Administration of oral analgesic medication or suppositories containing belladonna and opium prior to the instillation of RIMSO-50® can reduce bladder spasm In patients with severe interstitial cystitis with very sensitive bladders, the initial treatment, and possibly the second and third (depending on patient response) should be done under anesthesia.
The FDA drug label does not answer the question.
From the Research
Conditions Causing a Rise in Cystitis
- Cystitis, also known as urinary tract infection (UTI), is a common bacterial infection that can be caused by various factors, including bacterial pathogens such as Escherichia coli, Proteus, Klebsiella, and Staphylococcus saprophyticus 2, 3.
- The annual incidence of UTIs is 12.1% among women and 3% among men, with recurrent UTIs occurring in 20% to 30% of women 2.
- Asymptomatic bacteriuria, or positive urine culture result without symptoms, can also lead to unnecessary antibiotic therapy and contribute to the rise in cystitis 2.
Risk Factors for Cystitis
- Women are more likely to develop cystitis than men, with the annual incidence of UTIs being 12.1% among women and 3% among men 2.
- Diabetes is also a risk factor for cystitis, with women with diabetes being more likely to develop UTIs 4.
- Renal function, particularly estimated glomerular filtration rate (eGFR), can also affect the treatment and outcome of cystitis, with decreased eGFR being associated with higher clinical failure rates 5.
Diagnosis and Treatment of Cystitis
- Cystitis can be diagnosed based on symptoms such as dysuria, frequency, and lower abdominal pain, as well as urine culture results 2, 3.
- Antibiotics such as nitrofurantoin, fosfomycin, and trimethoprim are commonly used to treat cystitis, with the choice of antibiotic depending on the severity of the infection, patient factors, and local resistance patterns 2, 4, 3, 5.
- The duration of treatment varies by specific drug and type of infection, ranging from 3 to 5 days for uncomplicated cystitis to 7 to 14 days for pyelonephritis 2, 3.