s Prevention of Recurrent Cystitis in Pre-Menopausal Women: From Mechanisms to Therapy

Recurrent cystitis is common among pre-menopausal, healthy, non-pregnant women. Each episode of urinary tract infection (UTI) results in loss of working hours and quality of personal life. Most of recurrent UTIs are caused by uropathogenic Escherichia coli (UPEC). Its infectivity is in part due to the acquisition of pilli with an adhesin for mannose-containing receptors of the bladder. UTI-prone women are believed to have a compromised immune response, so even after a successful resolution of the infection reinfection is common. Many risk factors contribute to recurrence of UTI, including frequency of intercourse, new sex partners, diaphragm use, and age of first UTI. Pivmecillinam, nitrofurantoin, trimethoprim/ sulfamethoxazole, and fofomycin are considered first-line agents against cystitis. Short-term 3-day antibacterial regimens with quinolones are used as second-line agents in order to prevent emergence of antimicrobial resistance to them. Low doses of any of the aforementioned antibacterials can be used for prophylaxis against recurrences. An immunostimulant extracted from 18 heat-killed Escherichia coli strains of 5 different serotypes (URO-VAXOM), given orally once daily for 3 months has been tested and shown to have good efficacy for prophylaxis of recurrent UTIs. Cranberry products are also effective for prophylaxis, however with high rates of withdrawal. Oral Dmannose can bind pilli and their adhesin, which are essential for binding, invasion and formation of biofilm, however more clinical data are needed to support its use. Probiotics are the second most tested prophylactic agents after antibiotics; their efficacy varies according to the type of administered probiotic.