The corresponding, effective, timely therapy of any IMP leads to a significantly higher frequency of symptomatic and bacteriological cure and better prevention of reinfection. Unfortunately, treatment can lead to antibiotic resistance to pathogens and commentary bacteria and have adverse effects on the intestinal and vaginal flora, so it is very important to immediately consult a doctor and choose it correctly.
Clinical recommendations for the treatment of acute uncomplicated cystitis
The American society of infectious disease specialists (IDSA) in cooperation with the European Society of Microbiology and Infectious Diseases (ESCMID) published clinical recommendations for treatment with acute uncomplicated cystitis and pyelonephritis in 2011. This document became an invaluable reference in the Office of the Imp. This manual discusses important factors in choosing the optimal treatment:
- the nature of the resistance of the uropathogens;
- sensitivity of urepatogenic bacteria to antimicrobial drugs;
- The possibility of side effects of antimicrobial drugs.
As for sensitivity, two important facts are noted in this leadership:
- The stability of uropathogens to antibiotics has increased in recent years;
- The nature of resistance demonstrates significant geographical variability between countries and even regions.
Thus, the recommendations periodically revise due to constantly developing resistance, the development of new tools and conducting research showing the superiority and inefficiency of drugs. According to and recommendations and research, they are best met with the requirements for drugs for the treatment of uncomplicated cystitis, the following substances:
- phosphomicin;
- nitrofurantin.
The following selection criteria were used: pharmacokinetics, interaction, the probability of hitting (the probability that microorganism is sensitive to antibiotics), the development of resistance, specific use for IMPs, effectiveness, side effects, dosage frequency, duration of treatment, cost.
The study included the following drugs: amoxicillin (with or without clavulanic acid), nitrofurantin, sulfametizol, trimtoprime, co-trimoxazole, ciprofloxacin, norfloxacin, offloxacin and phosphomicin Trometamol.
Characterization of the first line of treatment of infections of the lower urinary tract
Table 1. First line for the treatment of cystitis
| Substance | Dosage | The duration of treatment |
| Phosfomicin Trometamol | 3 g a single dose | A single dose (once) |
| Nitrofurantin | 50-100 mg four times a day | 5-7 days |
Phosfomicin Trometamol
Phosfomycin was opened in 1969 as a representative of the new class of phosphone antibiotics.
Active substance: phosphomicin. Release form: granules for the preparation of the solution, in packaging 1 or 2 packages, dosage of phosphomicin 3 g/bag, 2 g/bag.
It refers to the clinical and farmacological group to uroantiseptics, antibiotics (derivative of phosphonic acid).
Spectrum of action
Phosfomycin has a bactericidal activity of a wide spectrum of action in relation to:
- staphylococci (Staphylococcus spp. );
- Enterococci (Enterococcus spp. );
- Haemophilus spp;
- most intestinal gram-negative bacteria, including 95. 5% E. coli, producing β-lactamases of the expanded spectrum (BLRS);
- E. coli strains producing metal-β-lactamase sensitive to phosphomicin;
- Citrobacter spp. ;
- Enterobacter spp. ;
- Klebsiella spp. , Klebsiella pneumoniae;
- Morganella Morganii;
- Proteus mirabilis;
- Pseudomonas spp. ;
- Serratia spp.
The peculiarity of the drug
- Trometamol phosphomicin is prescribed exclusively for the treatment of acute uncomplicated cystitis in the form of a single dose of 3 g and not prescribed for pyelonephritis.
- It is best absorbed if you take it before eating.
- Reaches a high concentration in the urine and retains a high level for more than 24 hours.
In several studies, the clinical and microbiological effectiveness of phosphomicin with other antimicrobials of the first row with uncomplicated cystitis was compared. The clinical efficiency of one dose (3 g) of phosphomicin is 91% (cure occurs in 91% of patients). The indicator is comparable to nitrofurantoine (93%), trimetrome-sulfametoxazole (93%) and fluoroquinolones (90%) in acute uncomplicated cystitis.
Advantages of treatment with phosphomicin
The microbiological level of cure phosphomicin (80%) is lower than that of comparable antibiotics by 88–94%. However, a recent meta -analysis of 27 studies did not reveal the differences in the effectiveness between phosphomicin and other antibiotics for the treatment of cystitis and discovered the following facts:
- Phosfomycin causes significantly less adverse reactions, which is the most important - including in pregnant women.
- An additional benefit is to treat multi -resistant microorganisms. Several studies of In vitro demonstrated that phosphomicin is active in relation to vancico-resisted Staphylococcus aureus and gram-negative sticks producing BLRS.
- Effective in the treatment of IMP caused by K. pneumoniae. enterobacteriaceae producing carbapenemase (in doses of 3 g, repeat every 48–72 hours).
- It has a minimal side effect on the body. This is indicated by the high frequency of the susceptibility of E. coli in regions with frequent use of phosphomicin with uncomplicated cystitis in women;
- Convenience of a single dose mode.
Indications
- acute cystitis (bacterial origin);
- exacerbation of recurrent cystitis (bacterial origin);
- urethritis (bacterial non -specific);
- Bacteriuria of pregnant women asymptomatic;
- IMP after operations;
- Prevention of imp.
Dosage and method of application
| Treatment of simple acute cystitis | Recurrent/heavy forms of imp | Prevention of imp |
| Adults - 3. 0 g (1 package) once
Children (from 5 years old) - 2. 0 g once |
Adults - 3. 0 g two times, the second reception after 24 hours | First technique: 3. 0 g 3 hours before the operation/diagnostic procedure
Second trick: 3. 0 g 24 hours after the primary |
Recommendations for use
- Follow all the instructions on the label.
- Phosfomycin is usually prescribed only in one dose.
- Do not take in large/smaller quantities or longer if it is not prescribed by a doctor.
- It can be used simultaneously/after eating.
- Phosfomycin is a powder drug, before use it must be diluted with water. Do not take dry powder without adding water.
- Dissolve a bag of 1/2 cup of cold water, mix and drink immediately. You can add a little more water to the same glass, carefully shake and drink immediately to ensure a complete dosage.
- Do not mix with hot water.
- It's good to take it overnight. There will be a longer break between urination, which will ensure a longer presence of the drug in the bladder and a more effective effect.
- Store at room temperature away from moisture and heat in the original packaging.
Other instructions:
- Symptoms can not completely pass immediately, after 2-3 days;
- It is necessary to contact a urologist if the symptoms do not disappear within 3 days after treatment, a fever or other new complaints will appear;
- Before applying the patient, it is recommended to consult a doctor to make sure that phosphomicin is a suitable antibiotic for treatment. In addition, urine analysis may be required before and after taking this medicine.
Contraindications:
- Children under 5 years old;
- allergic reactions to components;
- Severe renal failure.
General side effects:
- nausea, stomach disorder, slight diarrhea;
- headache, dizziness;
- Itching or vaginal discharge (rarely).
Drug interaction
Simultaneous intake with meteclopramide is not recommended to avoid weakening the action of phosphomicin.
Thus, the convenience of a single dose regime, in vitro activity in relation to resistant gram -negative sticks that cause both simple and immature, uncomplicated cystitis, And the minimum tendency to side damage makes phosphomicin a useful choice in the treatment of infections of the lower MVP (cystitis, urethritis).
Nitrofurantin
Active substance: nitrofurantin. Release form: tablets, dosage 100 mg, 50 mg.
It refers according to the clinical and farmacological group to uroantiseptics, antimicrobials.
Nitrofurantin, related to the group of synthetic nitrofurans, was originally presented in the form of a microcrystalline form. In 1967, the form of macrocrystalline with improved gastrointestinal tolerance became available.
Currently, there are two main types of nitrofurantin: a macrocrystalline form and a mixture of microcrystalline and macrocrystalline forms (25 mg of macrocrystals plus 75 mg of monohydrate). Mixed species in the patented double delivery system, in the Russian Federation are not registered and are not in circulation.
The mechanism of action
The mechanisms of bacterial activity of nitrofurantin include several sites:
- inhibiting of ribosomal broadcasting;
- damage to bacterial DNA;
- Intervention in the Crebs cycle.
Nitrofurantin is active in relation to:
- more than 90% of the intestinal strains causing the IMP;
- Enterococcus, including resistant to Vancromicin;
- Klebsiella spp. ;
- Proteus spp. ;
- Staphylococci (golden and saprophytic) are usually susceptible.
Resistance to the drug is rare, probably due to multiple areas of the drug. However, Proteus, Serratia and Pseudomonas have natural resistance to nitrofurantoine.
Nitrofurantino can also be an additional option for oral antimicrobial treatment of acute uncomplicated cystitis caused by bacteria producing BLRS.
Pharmacokinetics. The absorption improves when eating. The concentrations of nitrofurantin in serum are low or are not defined at standard doses, the content of the prostate gland is not detected. It is excreted mainly with urine, where the concentration of the drug (from 50 to 250 mg/ml) easily exceeds 32 mg/ml MPC.
Nitrofurantin should not be prescribed to patients with pronounced renal failure (creatinine clearance <60 m/min), but the studies observed high efficiency of the drug in patients with creatinine clearance of 60-30 ml/min.
Safe for use in pregnant women and children.
Indications: cystitis (bacterial origin) Treatment and prevention.
Dosage. It is prescribed by a urologist individually based on the severity of the state, duration and severity of symptoms.
The usual dose for adults with cystitis:
- From 50 to 100 mg orally 4 times a day for 1 week or for at least 3 days after urine sterility reaches. The usual dose for adults for the prevention of cystitis:
- From 50 to 100 mg orally once a day before bedtime. Children's dosage for the treatment of cystitis:
- 1 month and older: 5–7 mg/kg/day (up to 400 mg/day) orally in 4 doses. The usual children's dose for the prevention of cystitis:
- 1 month and older: from 1 to 2 mg/kg/day (up to 100 mg/day) orally in 1-2 receptions.
Most experts agree with the recommendation of a 5-day course of the drug for the treatment of acute uncomplicated cystitis. Studies showed the frequency of early clinical cure with nitrofurantoine from 79% to 95% and the frequency of microbiological cure from 79 to 92%. In the aggregate of the study of clinical effectiveness, they indicate the general equivalence between nitrofurantoin, prescribed for 5 or 7 days, and trimetrome-sulfametoxazole (beads), cyprofloxacin and a single dose of Trometamol phosphomycin (Monural). However, the speed of microbiological cure has constantly demonstrated a slightly more favorable effect for comparison drugs.
Recommendations to patients
- It is necessary to follow all the doctor's prescriptions and instructions in the instructions for the drug.
- Do not use in large or smaller quantities or longer than recommended.
- It is better to take nitrofurantin with food (bioavailability rises).
- It is recommended to observe the reception during the entire prescribed period. Symptoms can pass earlier, but the treatment cannot be stopped while the infection is completely eliminated. Doses can increase the risk of further development of infection resistant to antibiotics and the risk of relapse.
- Nitrofurantin does not treat viral infections, for example, a cold or flu.
Side effect
General side effects:
- headache, dizziness;
- gas formation, stomach disorder;
- light diarrhea;
- Itching or vaginal discharge.
Much less often are found:
- watery or bloody diarrhea;
- sudden pain or discomfort in the chest, whistling breathing, dry cough;
- difficulty breathing;
- fever, chills, aches in the body, fatigue, inexplicable weight loss;
- numbness, tingling or pain in the hands or legs;
- liver problems - nausea, pain in the upper part of the stomach, itching, feeling of fatigue, loss of appetite, dark urine, stool of clay, jaundice (yellowing of the skin or eye);
- The lupid -like syndrome - joint pain or edema with fever, swollen glands, muscle pain, chest pain, vomiting, unusual thoughts or behavior, spotted rashes.
Serious side effects can be more likely in the elderly, long -term sick or weakened people.
Contraindications:
- serious disorders of the excretory function of the kidneys;
- renal failure;
- Oliguria;
- glucose-6-phosphate dehydrogenase failure;
- pregnancy;
- age up to 1 month;
- allergic reactions to components;
- XN II-III stages;
- cirrhosis;
- chronic hepatitis;
- acute porphyria;
- lactation.
Application in pregnancy
The category of the drug in relation to pregnancy: in (according to FDA - US health agency). It is believed that this medicine will not harm an unborn child in the early stages of pregnancy. At the last 2-4 weeks of pregnancy, it is contraindicated.
Nitrofurantin is able to penetrate into breast milk, during lactation is not prescribed.
Special instructions
- The risk of peripheral neuropathy increases in the presence of anemia, diabetes mellitus, severe Mon, violation of the electrolyte balance, a lack of vitamins of group B.
- Nitrofurantin is not used for the treatment of prostatitis, lesions of the cortical substance of the kidneys, purulent paranephritis. With pyelonephritis, they are not prescribed due to inefficiency.
- Nitrofurantin can give unusual results with certain laboratory glucose (sugar) in the urine.
Drug interaction
- With fluoroquinolons is incompatible.
- Antacids based on the magnesium of trilicate, Nastyx acid while taking the antimicrobial activity of nitrofurantin.
- Channel secretion that blocks the channel secretion is not prescribed, since they increase the toxicity of nitrofurantin (the blood content increases), reduce bactericidal properties (the content in the urine is reduced).
Nitrofurantin is considered the therapeutic remedy of the first line in acute uncomplicated cystitis due to:
- the effectiveness of a 5-day course;
- a small risk of side effects and damage to the normal flora of a person;
- minimum resistance of bacteria;
- effectiveness comparable to other antimicrobial drugs.