Cystitis treatment

You should advise the patient that cystitis is quite common among women but it is important to drink plenty of fluids to ensure the bladder is flushed thoroughly. Offer a potassium-based proprietary cystitis treatment such as Cystopurin. Advise the patient about the importance of wiping herself from front to back after visiting the toilet and that wearing loose clothing and cotton underwear is sometimes helpful. 

The proteolytic enzymes, trypsin, chymotrypsin, and chymoral [8076-22-0] in combination, have been used for the treatment of post-operative hand trauma, athletic injuries, and sciatica (214—216). Trypsin has also been used successfully in treating hyaline membrane disease of newborn babies, a condition usually fatal without treatment (217). Immobilized preparations of trypsin are useful in treating acute radiation cystitis following pelvic x-irradiation therapy (218). 

Warren JW, Abrutyn E, Hebei JR, et al. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis. Clin Infect Dis 1999 29 745-758. 

If hemorrhagic cystitis occurs, the goals of treatment are to decrease exposure to the offending etiology, establish and maintain urine outflow, avoid obstruction and renal compromise, and maintain blood and plasma volume. Restoration of normal bladder function is the ultimate goal following acute treatment. 

Treatment of hemorrhagic cystitis. IV, intravenous. (Data from ref. 24.)... 

West NJ. Prevention and treatment of hemorrhagic cystitis. Pharmacotherapy 1997 17 696-706. 

The answer is c. (Hardman, pp 1238-1239.) Remission maintenance can be carried out by combination therapy, which includes cyclophosphamide. Cyclophosphamide causes hemorrhagic cystitis. Doxorubicin and carmustine are useful in the treatment of acute lymphatic leukemia, but neither is known to cause hemorrhagic cystitis. 

Cystitis is a condition where urinary tract bacterial infection is presented. Products recommended as first-line of treatment include amoxicillin, oral cephalosporin, trimethoprim or nitrofurantoin. Doxycycline is a tetracycline antibacterial agent whereas itraconazole is an antifungal agent. 

Nitrofurantoin monohydrate/macrocrystals is indicated only for the treatment of acute uncomplicated UTIs (acute cystitis) caused by susceptible strains of E. coli or Staphylococcus saprophyticus in patients 12 years of age and older. 

MG Waters, JF Suleskey, LJ Finkelstein, ME Van Overbeke, VJ Zizza, M Stommel. Interstitial cystitis a retrospective analysis of treatment with pentosan polysulfate and follow-up patient survey. J Am Osteo Assoc 100 S13-S18, 2000. 

The anti-cancer drug cyclophosphamide causes cystitis. This drug may be essential in the patients treatment so a second drug is always given to relieve or avoid this common reaction. 

Reductions in renal and hepatic function do not alter plasma drug concentrations, and ketoconazole is not removed by hemodialysis or peritoneal dialysis. Penetration into cerebrospinal fluid is negligible, so that ketoconazole is ineffective in the treatment of fungal meningitis. Since only small amounts of active drug appear in the urine, ketoconazole is not effective in the treatment of Candida cystitis. 

A toxicity that is unique to cyclophosphamide and ifosfamide is cystitis. Dysuria and decreased urinary frequency are the most common symptoms. Rarely, fibrosis and a permanently decreased bladder capacity may ensue. The risk of development of carcinoma of the bladder also is increased. Large intravenous doses have resulted in impairment of renal water excretion, hyponatremia, and increased urine osmolarity and have been associated with hemorrhagic subendocardial necrosis, arrhythmias, and congestive heart failure. Interstitial pulmonary fibrosis may also result from chronic treatment. Other effects of chronic drug treatment include infertility, amenorrhea, and possible mutagenesis and carcinogenesis. 

Glucocorticoids are also used in the treatment of a number of HIV-related disorders, including Pneumocystis carinii pneumonia, demyelinating peripheral neuropathies, tuberculous meningitis, and nephropathy. Glucocorticoids are used as adjunctive therapy in Pneumo cystitis carinii pneumonia to decrease the inflammatory response and allow time for antimicrobial agents to exert their effects. In patients who are immunocompromised because of HIV infection, adjunctive steroids may be less beneficial in promoting survival. 

It produces direct relaxant action on smooth muscle with analgesic and anaesthetic action and used in the treatment of dysuria, nocturia and urinary urgency and frequency associated with cystitis and urethritis. 

Atropine and other antimuscarinic drugs have been used to provide symptomatic relief in the treatment of urinary urgency caused by minor inflammatory bladder disorders (Table 8-3). However, specific antimicrobial therapy is essential in bacterial cystitis. In the human urinary bladder, M2 and M3 receptors are expressed predominantly with the M3 subtype mediating direct activation of contraction. As in intestinal smooth muscle, the M2 subtype appears to act indirectly by inhibiting relaxation by norepinephrine and epinephrine. 

Treatment with large doses of cyclophosphamide carries considerable risk of pancytopenia and hemorrhagic cystitis and therefore is generally combined with stem cell rescue (transplant) procedures. Although cyclophosphamide appears to induce tolerance for... 

Levine LA, Jarrard DF. Treatment of cyclophosphamide-induced hemorrhagic cystitis with intravesical carboprost tromethamine. J Urol 1993 149(4) 719-23. 

Ispaghula is believed to have demulcent and laxative properties. Traditionally, ispaghula has been used in the treatment of chronic constipation, dysentery, diarrhea, and cystitis. It may applied topically as a poultice for furunculosis. 

Marshmallow has demulcent, expectorant, emollient, diuretic, antilithic, and vulnerary properties. Traditionally, it has been used internally for the treatment of respiratory catarrh and cough, peptic ulceration, inflammation of the mouth and pharynx, enteritis, cystitis, urethritis and urinary calculus, and topically for abscesses, boils, and varicose and thrombotic ulcers. 

Meadowsweet is reputed to have stomachic, mild urinary antiseptic, antirheumatic, astringent, and antacid properties. Traditionally, it has been used for atonic dyspepsia with heartburn and hyperacidity, acute catarrhal cystitis, rheumatic muscle and joint pains, diarrhea in children, and specifically for the prophylaxis and treatment of peptic ulcers. 

Cyclophosphamide (Cytoxan and Endoxan) is used in the treatment of Hodgkin s disease, lymphosarcoma, and other lymphomas. It is employed as a secondary drug in patients with acute leukemia and in combination with doxorubicin in women with breast cancer. A drug combination effective in the treatment of breast cancer is cyclophosphamide, methotrexate, fluorouracil, and prednisone (CMFP). Cyclophosphamide is also an immunosuppressive agent. The toxicity of cyclophosphamide causes alopecia, bone marrow depression, nausea and vomiting, and hemorrhagic cystitis. 

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