The presence of bacteria in the urine is a cause of cystitis, one of the most common urinary tract infections characterized by inflammation of the bladder. Cystitis generally affects more women than it does men. Its treatment also involves the use of antibiotics; however, such therapy can sometimes result in a few unwanted complications: “What absolutely must be avoided is the misuse of antibiotics, both by family doctors who are often approached in cases involving cystitis, as well as by patients” warns Dr. Alberto Saita, Urologist at Humanitas.
Apart from urology, the misuse of antibiotics is a root cause of one of the most serious threats to global public health: antibiotic resistance developed by pathogens. Antibiotic resistance only makes it much more difficult to treat cystitis and it causes other bacterial infections. According to the Italian Society of Urology, in around 40% of cases involving cystitis, antibiotics are misused.
In addition to data gathered on resistance in recent years, another fact has emerged: “Once upon a time, it was mainly E.coli that caused the first episode of cystitis” recalls Dr Saita. “Today, cystitis is also brought about by klebsiella, for example. The origin of these bacteria can be food-borne in light of the excessive use of antibiotics in animals who are to be slaughtered” explains Dr. Saita.
Treatment for a bacterial infection
What is important is to be able to understand in which cases antibiotics should be used. “Cystitis is an infection which, when it is episodic, tends to go away on its own. Healing occurs when the urothelial cells of the bladder are spontaneously repaired and therefore, the use of antibiotics would only accelerate the time it takes to treat cystitis. With antibiotic therapy, resolution of cystitis is almost immediate.”
In the case of recurrent cystitis, “it is necessary to start by assessing the infection more thoroughly and observing the urinary tract with an ultrasound to rule out the presence of small abscesses, ureteral stones or urine stagnation. Also, a gynecological examination is recommended to rule out possible vaginitis. In turn, the symptomology determines the treatment. If there is only bacteriuria or the presence of bacteria in the urine, but no other symptoms, then antibiotics can be avoided. In such cases, treatment with anti-inflammatory and urinary acidifiers is recommended. If other symptoms, such as fever, are present, it may be necessary to resort to antibiotic therapy.”
“In cases of cystitis with the presence of fever, the immediate use of antibiotics may be helpful in determining urine culture or confirming a bacterial pattern. Typically, – continues the expert – antibiotic therapy is made up of quinolones and lasts shortly, around three days. Prolonged use of the therapy is around 15 days; however, it is only advised for patients with a complicated and suspected infection such as pyelonephritis, which is an infection that triggers inflammation of the pelvis and kidneys”
A typical case involving the misuse of antibiotics is when the drugs are continuously used for recurrent cystitis: “A patient who is suffering from cystitis may choose to undergo antibiotic therapy. If, after less than a month, they develop an infection without the presence of any symptoms or rather the presence of bacteria, antibiotic therapy is not advised” emphasizes Dr. Saita. “With such practices, we merely support antibiotic resistance and increase the risk of creating selected strains of resistant bacteria. This, in turn, can lead to the presence of superinfections, which add to the first bacterial infection present.”
In what way can the use of antibiotics be limited? “For recurrent cystitis, it is possible to treat symptoms by introducing anti-inflammatory drugs or by stimulating the immune system’s defense mechanism. Cystitis episodes often occur during periods of high-stress and in such instances, it is possible to strengthen the immune system with multivitamin therapy, without having to wait for the onset of symptoms. It is also advised to follow a diet rich in vegetables and plenty of protein, as nutrients are essential for ensuring the proper functioning of the organs.”
Patients’ choices are also important: “Self-medication must be avoided. In case of relapses, it is advised to undergo the same antibiotic therapy whenever necessary” concludes Dr. Saita.