Clinical recommendations for the treatment of uncomplicated acute cystitisThe American Society of Infectious Disease Specialists (IDSA) in cooperation with the European Company of Microbiology and Infectious Diseases (ESCMID) has published clinical recommendations for treatment with cystitis and acute uncompiusal pyelonephritis in 2011. This document has become an invaluable reference to the IMP. This manual deals with important factors in the choice of optimal treatment:the nature of the resistance of 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 antibiotic uropathogens has increased in recent years; The nature of the resistance demonstrates significant geographic variability between countries and even regions. Thus, the recommendations periodically revise due to the resistance constantly in development, the development of new tools and the search for research showing the superiority and ineffectiveness of drugs. According to recommendations and research, they are better satisfied with the requirements of drugs for the treatment of uncomplicated cystitis, the following substances:phosphomicine;Nitrofurantine.The following selection criteria were used: pharmacokinetics, interaction, probability of hitting (the probability that microorganism is sensitive to antibiotics), the development of resistance, specific use of IP, efficiency, side effects, dose frequency, duration of treatment, cost. The study included the following drugs: amoxicillin (with or without clavulanic acid), nitrofurantine, sulfametizol, trimtoprime, co-trimoxazole, ciprofloxacin, norfloxacin, offloxacin and phosphomicine trometamol. Characterization of the first line of treatment of lower urinary tract infectionsTable 1. First line for cystitis treatment
SubstanceDosageThe duration of treatmentPhosfomicine Trometamol3 g only one doseOne dose (once)Nitrofurantine
50-100 mg four times a day5-7 days
Phosfomicine TrometamolPhosfomycin was opened in 1969 as a representative of the new class of phosphones antibiotics. Active substance: phosphomicine. Liberation form: granules for the preparation of the solution, in packaging 1 or 2 packages, phosphomicine dosage 3 g / bag, 2 g / bag.It refers to the clinical and clinical group in urosteptics, antibiotics (derived from phosphonic acid). Action spectrumPhosfomycin has a bactericidal activity of a wide range of action compared to:Staphylococci (Staphylococcus spp. ); Enterococci (Enterococcus spp. ); Haemophilus SPP;Most Gram-negative intestinal bacteria, including 95, 5% E. coli, producing β-lactamas of the extended spectrum (BLR);The strains of E. Coli producing metal-β-lactamase sensitive to phosphomicine;Citrobacter SPP. ; Enterobacter SPP. ;Klebsiella spp. , Klebsiella pneumoniae; Morganella Morganii; Proteus Mirabilis; Pseudomonas spp. ; Serratia spp. The particularity of the drugPhosphomicine trometamol is prescribed exclusively for the treatment of uncomplicated acute cystitis in the form of a single dose of 3 g and not prescribed for pyelonephritis. It is best to absorb 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 efficiency of phosphomicine with other antimicrobials of the first row with uncomplicated cystitis was compared. The clinical efficiency of a dose (3 g) of phosphomicine is 91% (healing occurs in 91% of patients). The indicator is comparable to the nitrofurantoine (93%), the tritrome-sulfametoxazole (93%) and fluoroquinolones (90%) in uncomplicated acute cystitis. Advantages of phosphomicine treatmentThe microbiological level of healing of phosphomicine (80%) is lower than that of comparable antibiotics from 88 to 94%. However, a recent meta-analysis of 27 studies has not revealed the differences in effectiveness between phosphomicine and other antibiotics for the treatment of cystitis and discovered the following facts:Phosfomycin causes significantly less undesirable reactions, which is most important - including in pregnant women.An additional advantage is to treat multi-resistant microorganisms. Several studies on in vitro have shown that phosphomicine is active compared to Staphylococcus aureus and gram-negative sticks that produced BLRs. Effective in the treatment of the imp cause by K. pneumoniae. Enterobacteriaceae producing carbapenemase (in doses of 3 g, repeat every 48 at 72 hours). It has a minimum side effect on the body. This is indicated by the high frequency of E. Coli in regions with frequent use of phosphomicin with uncomplicated cystitis in women;Convenience of a single dose mode.Indicationsacute cystitis (bacterial origin);exacerbation of recurring cystitis (bacterial origin);Uretrite (non -specific bacterial);Bacteriuria of asymptomatic pregnant women;Imp after operations;Imp prevention.Dosage and application method
Simple acute cystitis treatmentRecurring / heavy formsPrevention of IMPAdults - 3, 0 g (1 package) once
Children (5 years old) - 2, 0 g onceAdults - 3. 0 g twice, the second reception after 24 hoursFirst technique: 3, 0 g 3 hours before the operating / diagnostic procedure
Second tip: 3, 0 g 24 hours after primary
Recommendations for useFollow all the instructions on the label. Phosfomycin is generally only prescribed one dose. Do not take large / smaller or more quantities if it is not prescribed by a doctor.It can be used simultaneously / after eating.Phosfomycin is a powder medication, before using it, it should be diluted with water. Do not take dry powder without adding water.Dissolve a 1/2 cup of cold water bag, mix and drink immediately. You can add a little more water to the same glass, shake and drink carefully immediately to ensure a complete dose. 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.Keep at room temperature far from humidity and heat in the original packaging.Other instructions:Symptoms cannot pass completely immediately, after 2 to 3 days;It is necessary to contact a urologist if the symptoms do not disappear within 3 days of treatment, a fever or other new complaints will appear;Before applying the patient, it is recommended to consult a doctor to ensure that phosphomicine is an appropriate antibiotic for treatment. In addition, an urine analysis may be necessary before and after taking this medication.Contraindications:Children under the age of 5;allergic reactions to components; Severe renal failure.General side effects:nausea, stomach disorder, slight diarrhea;Headache, dizziness;Itching or vaginal losses (rarely).Drug interactionThe simultaneous contribution with the meteclopramide is not recommended to avoid weakening the action of phosphomicin.Thus, the convenience of a single dose dose, an in vitro activity compared to resistant gram sticks which cause both a simple and immature and uncomplicated cystitis, , And the minimum trend in secondary damage makes phosphomicine a useful choice in the treatment of infections of the lower MVP (cystitis, urettite).Nitrofurantine Active substance: nitrofurantine. Liberation form: tablets, 100 mg dosage, 50 mg.According to the clinical group and firm to urosteptics, antimicrobials, according to the clinical group. Nitrofurantine, linked to the synthetic nitrofurans group, was originally presented in the form of a microcrystalline shape. In 1967, the form of macrocrystalline with improved gastrointestinal tolerance became available. Currently, there are two main types of nitrofurantine: a macrocrystalline shape and a mixture of microcrystalline and macrocrystalline shapes (25 mg of macrocrystals plus 75 mg monohydrate). Mixed species in the patented double delivery system, in the Russian Federation, are not recorded and are not in circulation. The action mechanismNitrofurantine bacterial activity mechanisms include several sites:inhibition of ribosomal broadcasting; bacterial DNA damage;Intervention in the Crebs cycle. Nitrofurantine is active in relation to: Over 90% of the intestinal strains causing the IMP;Enterococcus, including vancromicin resistant;Klebsiella spp. ; Proteus SPP. ;Staphylococci (golden and saprophytes) are generally sensitive.Resistance to medication is rare, probably due to several areas of the drug. However, Proteus, Serratia and Pseudomonas have natural resistance to the nitrofurantoine. Nitrofurantino can also be an additional option for oral antimicrobial treatment of uncomplicated acute cystitis caused by bacteria producing BLRs. Pharmacokinetics. Absorption improves during consumption. Nitrofurantine concentrations in serum are low or are not defined in 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 of MPC. Nitrofurantine should not be prescribed to patients with pronounced renal failure (creatinine clearance<60 m / min), but studies have observed high efficiency of the drug in patients with creatine clearance from 60 to 30 ml / min. Sure for use in pregnant women and children.Indications: Treatment and prevention of cystitis (bacterial origin).Dosage. It is prescribed by an individually urologist on the basis of the severity of the state, duration and severity of symptoms. The usual dose for adults with cystitis:From 50 to 100 mg oral 4 times a day for 1 week or for at least 3 days after the end of the sterility of the urine. The usual dose for adults for the prevention of cystitis: From 50 to 100 mg orally once a day before bedtime. Dosage of children for cystitis treatment:1 month and more: 5–7 mg / kg / day (up to 400 mg / day) orally by 4 doses. The usual dose of children for the prevention of cystitis:1 month and more: 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 medication course for the treatment of uncomplicated acute cystitis. Studies have shown the frequency of early clinical treatment with nitrofurantoine from 79% to 95% and the frequency of the microbiological remedy from 79 to 92%. In the aggregate of the study of clinical efficiency, they indicate the general equivalence between nitrofurantoin, prescribed for 5 or 7 days and the trimeter-sulfametoxazole (balls), cyprofloxacin and a single dose of phosphomycin (monature) trometamol. However, the speed of the microbiological remedy has constantly demonstrated a slightly more favorable effect for comparison drugs. Recommendations to patientsIt is necessary to follow all the doctor's prescriptions and instructions in the drug instructions. Do not use large or smaller or more than recommended quantities.It is best to take nitrofurantine with food (bioavailability increases).It is recommended to observe reception during the entire prescribed period. Symptoms can pass earlier, but treatment cannot be stopped while infection is completely eliminated. Doses can increase the risk of subsequent development of an antibiotic resistant infection and the risk of relapse. Nitrofurantine does not treat viral infections, for example, a cold or a flu.Side effectGeneral side effects:Headache, dizziness;gas formation, stomach disorder;light diarrhea; Itching or vaginal discharge.We find much less often:Aqueous or bloody diarrhea;Sudden pain or discomfort in the chest, whistling breathing, dry cough;difficulty breathing;Fever, chills, body pain, 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, clay stool, jaundice (yellowing of the skin or eye); LUPID type syndrome - joint pain or edema with fever, swollen glands, muscle pain, chest pain, vomiting, thoughts or unusual behaviors, rashes.Serious side effects may be more likely in the elderly, long -term or weakened patients.Contraindications: serious troubles of the kidney excretory function; renal failure; Oliguria;Glucose-6-phosphate dehydrogenase failure; pregnancy;Aging up to 1 month;allergic reactions to components;XN II-III Internships; cirrhosis; chronic hepatitis; acute porphyria; lactation.Application during pregnancyThe drug category in relation to pregnancy: in (according to the FDA - US Health Agency). It is believed that this medication will not harm an unborn child in the early stages of pregnancy. During the last 2 to 4 weeks of pregnancy, it is contraindicated.Nitrofurantine is capable of entering breast milk during lactation is not prescribed.Special instructionsThe risk of peripheral neuropathy increases in the presence of anemia, diabetes mellitus, lun severe, violation of electrolytic balance, lack of vitamins of group B.Nitrofurantine 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 ineffectiveness.Nitrofurantine can give unusual results with certain laboratory glucose (sugar) in the urine.Drug interactionWith fluoroquinolons is incompatible.Antacids based on magnesium of trililic and nastyx acid while taking the antimicrobial activity of nitrofurantine.The secretion of channels that blocks the secretion of channels is not prescribed, as they increase the toxicity of nitrofurantine (the blood content increases), reduce bactericidal properties (urine content is reduced).Nitrofurantine is considered to be the therapeutic remedy of the first line in uncomplicated acute 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;Efficiency comparable to other antimicrobial drugs.
The study included the following drugs: amoxicillin (with or without clavulanic acid), nitrofurantine, sulfametizol, trimtoprime, co-trimoxazole, ciprofloxacin, norfloxacin, offloxacin and phosphomicine trometamol. Characterization of the first line of treatment of lower urinary tract infections
Table 1. First line for cystitis treatment Substance Dosage The duration of treatment Phosfomicine Trometamol 3 g only one dose One dose (once) Nitrofurantine 50-100 mg four times a day 5-7 days Phosfomicine Trometamol
Phosfomycin was opened in 1969 as a representative of the new class of phosphones antibiotics. Active substance: phosphomicine. Liberation form: granules for the preparation of the solution, in packaging 1 or 2 packages, phosphomicine dosage 3 g / bag, 2 g / bag. It refers to the clinical and clinical group in urosteptics, antibiotics (derived from phosphonic acid). Action spectrum
Phosfomycin has a bactericidal activity of a wide range of action compared to: Staphylococci (Staphylococcus spp. ); Enterococci (Enterococcus spp. ); Haemophilus SPP; Most Gram-negative intestinal bacteria, including 95, 5% E. coli, producing β-lactamas of the extended spectrum (BLR); The strains of E. Coli producing metal-β-lactamase sensitive to phosphomicine; Citrobacter SPP. ; Enterobacter SPP. ; Klebsiella spp. , Klebsiella pneumoniae; Morganella Morganii; Proteus Mirabilis; Pseudomonas spp. ; Serratia spp. The particularity of the drug
Phosphomicine trometamol is prescribed exclusively for the treatment of uncomplicated acute cystitis in the form of a single dose of 3 g and not prescribed for pyelonephritis. It is best to absorb 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 efficiency of phosphomicine with other antimicrobials of the first row with uncomplicated cystitis was compared. The clinical efficiency of a dose (3 g) of phosphomicine is 91% (healing occurs in 91% of patients). The indicator is comparable to the nitrofurantoine (93%), the tritrome-sulfametoxazole (93%) and fluoroquinolones (90%) in uncomplicated acute cystitis. Advantages of phosphomicine treatment
The microbiological level of healing of phosphomicine (80%) is lower than that of comparable antibiotics from 88 to 94%. However, a recent meta-analysis of 27 studies has not revealed the differences in effectiveness between phosphomicine and other antibiotics for the treatment of cystitis and discovered the following facts: Phosfomycin causes significantly less undesirable reactions, which is most important - including in pregnant women. An additional advantage is to treat multi-resistant microorganisms. Several studies on in vitro have shown that phosphomicine is active compared to Staphylococcus aureus and gram-negative sticks that produced BLRs. Effective in the treatment of the imp cause by K. pneumoniae. Enterobacteriaceae producing carbapenemase (in doses of 3 g, repeat every 48 at 72 hours). It has a minimum side effect on the body. This is indicated by the high frequency 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 recurring cystitis (bacterial origin); Uretrite (non -specific bacterial); Bacteriuria of asymptomatic pregnant women; Imp after operations; Imp prevention. Dosage and application method
Simple acute cystitis treatment Recurring / heavy forms Prevention of IMP Adults - 3, 0 g (1 package) once Children (5 years old) - 2, 0 g once Adults - 3. 0 g twice, the second reception after 24 hours First technique: 3, 0 g 3 hours before the operating / diagnostic procedure Second tip: 3, 0 g 24 hours after primary Recommendations for use
Follow all the instructions on the label. Phosfomycin is generally only prescribed one dose. Do not take large / smaller or more quantities if it is not prescribed by a doctor. It can be used simultaneously / after eating. Phosfomycin is a powder medication, before using it, it should be diluted with water. Do not take dry powder without adding water. Dissolve a 1/2 cup of cold water bag, mix and drink immediately. You can add a little more water to the same glass, shake and drink carefully immediately to ensure a complete dose. 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. Keep at room temperature far from humidity and heat in the original packaging. Other instructions: Symptoms cannot pass completely immediately, after 2 to 3 days; It is necessary to contact a urologist if the symptoms do not disappear within 3 days of treatment, a fever or other new complaints will appear; Before applying the patient, it is recommended to consult a doctor to ensure that phosphomicine is an appropriate antibiotic for treatment. In addition, an urine analysis may be necessary before and after taking this medication. Contraindications: Children under the age of 5; allergic reactions to components; Severe renal failure. General side effects: nausea, stomach disorder, slight diarrhea; Headache, dizziness; Itching or vaginal losses (rarely). Drug interaction
The simultaneous contribution with the meteclopramide is not recommended to avoid weakening the action of phosphomicin. Thus, the convenience of a single dose dose, an in vitro activity compared to resistant gram sticks which cause both a simple and immature and uncomplicated cystitis , , And the minimum trend in secondary damage makes phosphomicine a useful choice in the treatment of infections of the lower MVP (cystitis, urettite). Nitrofurantine
Active substance: nitrofurantine. Liberation form: tablets, 100 mg dosage, 50 mg. According to the clinical group and firm to urosteptics, antimicrobials, according to the clinical group. Nitrofurantine, linked to the synthetic nitrofurans group, was originally presented in the form of a microcrystalline shape. In 1967, the form of macrocrystalline with improved gastrointestinal tolerance became available. Currently, there are two main types of nitrofurantine: a macrocrystalline shape and a mixture of microcrystalline and macrocrystalline shapes (25 mg of macrocrystals plus 75 mg monohydrate). Mixed species in the patented double delivery system, in the Russian Federation, are not recorded and are not in circulation. The action mechanism
Nitrofurantine bacterial activity mechanisms include several sites: inhibition of ribosomal broadcasting; bacterial DNA damage; Intervention in the Crebs cycle. Nitrofurantine is active in relation to: Over 90% of the intestinal strains causing the IMP; Enterococcus, including vancromicin resistant; Klebsiella spp. ; Proteus SPP. ; Staphylococci (golden and saprophytes) are generally sensitive. Resistance to medication is rare, probably due to several areas of the drug. However, Proteus, Serratia and Pseudomonas have natural resistance to the nitrofurantoine. Nitrofurantino can also be an additional option for oral antimicrobial treatment of uncomplicated acute cystitis caused by bacteria producing BLRs. Pharmacokinetics. Absorption improves during consumption. Nitrofurantine concentrations in serum are low or are not defined in 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 of MPC. Nitrofurantine should not be prescribed to patients with pronounced renal failure (creatinine clearance<60 m / min), but studies have observed high efficiency of the drug in patients with creatine clearance from 60 to 30 ml / min. Sure for use in pregnant women and children. Indications: Treatment and prevention of cystitis (bacterial origin). Dosage. It is prescribed by an individually urologist on the basis of the severity of the state, duration and severity of symptoms. The usual dose for adults with cystitis: From 50 to 100 mg oral 4 times a day for 1 week or for at least 3 days after the end of the sterility of the urine. The usual dose for adults for the prevention of cystitis: From 50 to 100 mg orally once a day before bedtime. Dosage of children for cystitis treatment: 1 month and more: 5–7 mg / kg / day (up to 400 mg / day) orally by 4 doses. The usual dose of children for the prevention of cystitis: 1 month and more: 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 medication course for the treatment of uncomplicated acute cystitis. Studies have shown the frequency of early clinical treatment with nitrofurantoine from 79% to 95% and the frequency of the microbiological remedy from 79 to 92%. In the aggregate of the study of clinical efficiency, they indicate the general equivalence between nitrofurantoin, prescribed for 5 or 7 days and the trimeter-sulfametoxazole (balls), cyprofloxacin and a single dose of phosphomycin (monature) trometamol. However, the speed of the microbiological remedy 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 drug instructions. Do not use large or smaller or more than recommended quantities. It is best to take nitrofurantine with food (bioavailability increases). It is recommended to observe reception during the entire prescribed period. Symptoms can pass earlier, but treatment cannot be stopped while infection is completely eliminated. Doses can increase the risk of subsequent development of an antibiotic resistant infection and the risk of relapse. Nitrofurantine does not treat viral infections, for example, a cold or a flu. Side effect
General side effects: Headache, dizziness; gas formation, stomach disorder; light diarrhea; Itching or vaginal discharge. We find much less often: Aqueous or bloody diarrhea; Sudden pain or discomfort in the chest, whistling breathing, dry cough; difficulty breathing; Fever, chills, body pain, 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, clay stool, jaundice (yellowing of the skin or eye); LUPID type syndrome - joint pain or edema with fever, swollen glands, muscle pain, chest pain, vomiting, thoughts or unusual behaviors, rashes. Serious side effects may be more likely in the elderly, long -term or weakened patients. Contraindications: serious troubles of the kidney excretory function; renal failure; Oliguria; Glucose-6-phosphate dehydrogenase failure; pregnancy; Aging up to 1 month; allergic reactions to components; XN II-III Internships; cirrhosis; chronic hepatitis; acute porphyria; lactation. Application during pregnancy
The drug category in relation to pregnancy: in (according to the FDA - US Health Agency). It is believed that this medication will not harm an unborn child in the early stages of pregnancy. During the last 2 to 4 weeks of pregnancy, it is contraindicated. Nitrofurantine is capable of entering breast milk during lactation is not prescribed. Special instructions
The risk of peripheral neuropathy increases in the presence of anemia, diabetes mellitus, lun severe, violation of electrolytic balance, lack of vitamins of group B. Nitrofurantine 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 ineffectiveness. Nitrofurantine can give unusual results with certain laboratory glucose (sugar) in the urine. Drug interaction
With fluoroquinolons is incompatible. Antacids based on magnesium of trililic and nastyx acid while taking the antimicrobial activity of nitrofurantine. The secretion of channels that blocks the secretion of channels is not prescribed, as they increase the toxicity of nitrofurantine (the blood content increases), reduce bactericidal properties (urine content is reduced). Nitrofurantine is considered to be the therapeutic remedy of the first line in uncomplicated acute 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; Efficiency comparable to other antimicrobial drugs.