Results of treatment of acute uncomplicated cystitis in 440 women of working age in a large industrial city

Introduction. Lower urinary tract infections (UTIs) affect nearly two-thirds of all women during their lifetime, and many suffer from recurrent infections. There are evidence-based guidelines from several international societies and RSU for the evaluation and treatment of UTIs; however, adherence to these guidelines is not always optimal.

Aim. To study the immediate outcomes of treating acute uncomplicated cystitis in working-age women living in a large industrial city under unfavorable environmental and climatic conditions.

Materials and methods. A multicenter, randomized, open-label study was carried out in 4 outpatient clinics in Perm involving 440 women with acute uncomplicated cystitis. Depending on the treatment, the patients were divided into 4 groups. The main drug was the antibiotic fosfomycin trometamol, which was given at a single dose of 3 g to all 440 patients. In the group 1, monotherapy with fosfomycin trometamol was used. Patients in groups 2-4 received basic antibacterial therapy (3 g of fosfomycin trometamol), supplemented with symptomatic and herbal remedies. In the group 2, drotaverine was used at 80 mg 3 times a day for 2 days, in the group 3 phenazopyridine at a dose of 200 mg 3 times a day for 2 days was given, while in the group 4, Canephron N at 2 tablets 3 times a day for 6 days was administered. The symptoms of cystitis were assessed using the ACSS scale, visual analog scale (VAS) of pain, urinalysis with microscopic examination of urinary sediment, bacteriological examination of urine and other methods. The results were assessed after 6, 12, 24, 48 hours, 3 and 6 days.

Results. The sensitivity of microorganisms to fosfomycin in bacteriological studies was 97.2%. In group 1, recovery was achieved in 92.5%, improvement in 6.6%, and the bacteriological cure was 95.3%; however, the ACSS and VAS scales indicated insufficiently rapid elimination of pain and other symptoms. In the group 2, improvement in results was insignificant. However, results were significantly better in groups 3 and 4, with rapid resolution of pain, dysuria, and other symptoms. In group 3, recovery was achieved in 97.3%, bacteriological cure and disability period were 96.8% and 5.1±0.5 days, respectively. In group 4, recovery was observed in 96.4%, bacteriological cure was 96.6%, and disability period was 5.2±0.4 days, respectively. In total, for 440 patients, when using fosfomycin trometamol, recovery occurred in 95.2%, improvement in 4.6%, bacteriological cure was 96.4%, side effects of fosfomycin trometamol were noted only in 1.1% of cases.

Conclusions. Currently, even in unfavorable environmental and climatic conditions, fosfomycin trometamol remains a highly effective and safe antibacterial agent for the treatment of acute uncomplicated cystitis. It is recommended to combine the use of fosfomycin trometamol with a urinary analgetic drug and herbal preparation based on extracts of centaury, lovage and rosemary (Kanefron N).