Cystitis - a disease which once in my life met every third woman.Men face this problem much less frequently.Is it always the appearance of cystitis go to the doctor?Of course not.
episodes of the disease can occur spontaneously during the day and never in his life be repeated, but perhaps difficult, painful for the appearance of blood in the urine.Many are beginning to buy their own antibiotics and then claim that they helped.Indeed, the weight of antimicrobials used in cystitis, but some have long been ineffective (ie people feel temporary relief, but the causative agent of "go underground"), which is fraught with complications and relapses.Others may be unsafe in certain clinical situations.
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In this article, we will focus on preparations for the treatment of cystitis, recommended on the basis of evidence-based medicine, and their pros and cons.However, this does not mean that you need to self-medicate.Only a doctor can correctly make a dia
- 1 Principles of therapy cystitis
- 2 Antibacterials
- 2.1 fosfomycin - modern magic wand cystitis
- 2.2 beta-lactams - drugs cystitis for children andpregnant
- 2.3 Nitrofurans - first-line agents in cystitis
- 2.4 fluoroquinolones - a group of first-line or reserve?
There are a variety of drugs, which are called "affordable and long-proven drugs," but in fact they do not work anymore.Documents regulating drugs for the treatment of cystitis, change every year, taking into account the results of recent clinical trials and new drugs.
According to the recommendations Urological Association, acute cystitis is possible during the first day not to use antibiotics, and to drink more (best cranberry, cranberry fruit drinks, acidifying the urine), to comply with bed rest, take anti-inflammatory (eg ibuprofen, diclofenac) and antispasmodics(No-spa, Baralgin).
If no improvement within days prescribe antibiotics when they are the cause of the disease.In 77-95% of cases of acute uncomplicated cystitis pathogen is Escherichia coli.
, however, not to be treated at once, you need to be sure that it really is uncomplicated acute infection of the lower urinary tract, that is:
Otherwise, etiological antibiotic therapy is appointed from the first day.Complicated forms of infection and recurrent cystitis treated for other, alternative schemes are often based on the results of urine culture on individual sensitivity to antibiotics.
When cystitis bothers pain syndrome, which is recommended for elimination of antispasmodic and anti-inflammatory agents.This trend is symptomatic treatment.
If repeated episodes of illness, be sure to carry out prevention of recurrence.Escherichia coli - a natural inhabitant of the intestines, which can not be avoided forever.It occurs when it enters the urinary tract cystitis or not depends on the delicate balance between the aggressiveness of the microorganism and the state of human immunity.
post-menopausal women appoint more female hormones vaginally, as episodes of cystitis may be related to estrogen deficiency.
list of antibiotics used in cystitis, br, however, because of their availability and unauthorized use, resistance to E. coli it develops faster than new drugs appear.
So, now in Russia is no longer prescribed for cystitis following antibiotics and antimicrobial agents: ampicillin, amoxicillin, Nitroxoline (5-NOC), Co-trimoxazole (Biseptolum).
To date recommendations for treatment of acute uncomplicated cystitis as follows:
Fosfomycin trometamol (Monural) - the drug, which is the sole producer of the Italian company "Zambon".Since the advent of Monural become first-line treatment of cystitis due to many advantages:
fosfomycin acts slowly for 2-3 days, so do not consider it ineffective, if not a complete reduction of symptoms during the first day.
Not applicable Monural only in children less than 5 years, seniors older than 75 years and are hypersensitive to the drug.
Mild side effects such as nausea, vomiting, headache were found in 6% of patients in the study drug.
However Fosfomycin is widely used in Russia for more than 10 years may gradually getting used to it E. coli.
in clinic were more likely to treat patients who have not once applied the Monural.A single dose is used less often: usually doctors recommend the use of 24-th hour three grams of the drug again.Do not confuse Monural (antibiotic) with the preparation of the same company Monurel (BAA, cranberry extract).
group of beta-lactam antibiotics (penicillins and cephalosporins) has its advantages and disadvantages in the treatment of cystitis.
Among the advantages of the group the most important feature is security: these drugs disrupt the bacterial cell wall, providing a bactericidal effect, but harmless to the human body.Undesirable side effects more frequently (10% of cases) is an allergic reaction.
On the other hand, if there is no individual intolerance, drugs approved for use by pregnant and lactating, and children of any age, and the elderly.
amoxicillin with clavulanic acid (Augmentin, Amoxiclav, Amoxiclav Kvik- tab, Panklav, Ekoklav, Flemoklav Soljutab) significantly increases sensitivity to the preparation of E. coli, which allows to recommend amoxicillin / clavulanate as first-line treatment of acute cystitis, when the foreSafety outputs therapy.
Adverse effects of the drug in the form of irritation to the intestine can be decreased by taking medication at the beginning of a meal or using additional probiotics.
original drug Augmentin is, all of the research on the effectiveness of this combination were conducted by GlaxoSmithKline.Amoxiclav ("Lek") came later, but became more widely used because of the lower cost.
Additional studies comparing drugs Flemoklav Soljutab (Japanese company "Astellas Pharma") and Augmentin have shown that due to the patented form of microgranules Soljutab side effects on the background there are 2 times less.On the other hand, and the cost of somewhat higher.
Adults drug is given usually at 500/125 mg 3 times daily or 875/125 mg 2 times a day.Therapy should last 5-7 days, depending on the clinical situation.
also present standard therapy of cystitis Cephalosporin third generation Cefixime (Pantsef, Supraks Soljutab, Tseforal Soljutab).It is more effective in the short course of therapy than other beta-lactam antibiotics, but does not act on all the pathogens of cystitis.The drug is given to adults in a dosage of 400 mg once daily or 200 mg two times a day at least five days.Cefuroxime can be used at a dosage of 250 mg two times a day and five days.
Nitrofurans belong to the group of antimicrobials, which have long been widely used in the treatment of cystitis.A common feature of these funds is a bactericidal effect, low resistance main pathogens, but with a significant incidence of adverse events.Every third patient when taking nitrofurans complains of nausea, vomiting, abdominal pain, drowsiness, dizziness.This group has a fairly extensive list of contraindications in the form of kidney, liver and heart failure, and others.
nitrofurantoin (furadonin) comes in the form of tablets, coated with a protective sheath, cystitis is recommended at a dose of 100-150 mg 3-4 times a day.
Furazidin (Furagin, Furamag) is better tolerated than furadonin.The drug is effective due to its high sensitivity to E. coli and other pathogens of cystitis.Appointed by 100 mg 3 times a day.Duration of treatment - five days.
furazolidone creates high concentrations in the urine, so its use in the treatment of urinary tract infections is ineffective.Non-fluorinated quinolones
(oxolinic, nalidixic, pipemidievaya acid) is no longer used in the treatment of cystitis, to be replaced by a more powerful and effective medicines - fluoroquinolones.
Common features for this group of drugs is the high sensitivity flora causing cystitis, and accordingly, the efficiency, but the highest incidence of side effects and contraindications because of toxic effects on the human body.
Fluoroquinolones should not be used in patients under 18 years (!) Until it has musculoskeletal system, pregnant or lactating, a tendency to seizures and epilepsy.
Because of adverse reactions for the majority of this group are characterized by pain in muscles and joints, abdominal pain, nausea, vomiting, dizziness and drowsiness, may impair liver function, tendon rupture, heart rhythm disturbances, photodermatitis.
In addition, medical world is concerned about the growing resistance to this effective in a wide range of diseases group of drugs.
Perhaps that is why there is still no firm position on the place, which should deal with fluoroquinolones in the treatment of cystitis:
It is fair to note that the better the choice left to the doctor, because he will be able to choose an antibiotic based on age, clinical situation, concomitantpathology and other criteria.
Russian national guidelines indicate fluoroquinolones as a second-line drugs, and use of Ciprofloxacin (tsiprinol, Tsiprobay, Tsiprolet, TSifran, TSifran ML Ekotsifol) and Levofloxacin is considered not quite justified in uncomplicated cystitis.
If you choose this group, it occupies a leading position norfloxacin (nolitsin, Normaks, Norbaksin) due to its high concentration in the urine.It is administered in a dosage of 400 mg two times a day for 3 days.Perhaps the appointment of ofloxacin (Ofloksin, tarivid, Zofloks, Zanotsin, Zanotsin ML) - 200 mg 2 times a day.
proved that short courses of fluoroquinolones is preferable, and take these drugs more than 3 days does not make sense.
course, drugs acting on the cause of the disease, cystitis is only antibiotics.Vegetable, anti-inflammatory, antispasmodic drugs facilitate the symptoms but do not eliminate the pathogen.
huge choice of antibiotics for addressing the issue of the treatment should consult a doctor.And not when all preparations have already tried, and in the beginning of the treatment, from the first day.Then it can be sequential therapy, according to the standards, first appointed safer antibiotics, then reserve.
Remember the basic rule of medicine: «No nocere!» («Do no harm!").Often, self-harms the body no less than the disease.
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