9 best remedies for cystitis

*Overview of the best according to the editors of Healthy Food Near Me. About selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.

In the spring of 2020, in connection with the coronavirus pandemic, people talk about it so often and so much that it involuntarily begins to seem that this is the most “main” infection, information from all over the world is given in such a dense stream. But let’s not panic, and let’s talk about other pathogens. In addition to viral infections, bacterial or microbial ones have not disappeared. And among them, in the first place in terms of frequency of occurrence will be urinary tract infection, which occurs in an uncomplicated form.

By localization, damage to the renal pelvis is possible, with the development of pyelonephritis, ureters, bladder and urethra, but most often there are symptoms of acute cystitis, or bladder damage. Cystitis is much more common in women than in men, and, according to epidemiologists, every woman experiences signs of acute inflammation of the bladder during her life. In women, the peak of the disease falls on the fertile period, when the patient lives an active sexual life.

The second peak of incidence occurs in the period after the onset of menopause, that is, older than 50 years. It is clear why this happens: at a young age, a person leads an active sex life, and after menopause, a woman’s immunity decreases, and the time comes for various “chronic illnesses”: diabetes, excess weight. Finally, various disorders of urinary incontinence, or incontinence, may occur. In old age, the number of cases of cystitis in women and men becomes equal: men begin to suffer from benign prostatic hyperplasia, or “adenoma” of the prostate, and this allows to achieve approximately the same incidence rates.

Definition and symptoms

What is cystitis? Cystitis “in its purest form” is an acute or chronic inflammation of the mucosa and more deeply lying submucosa of the bladder. Very often, cystitis is combined with urethritis, and this situation occurs for a number of reasons. In total there are several ways of infection. Most often, pathogenic microorganisms penetrate into the bladder from the bottom up, from the urethra, and into the urethra from the rectum and perianal zone. In women, this path is much more common than in men, due to the proximity of the urethra to the perianal zone and anus. In men, for known reasons, the external opening of the urethra is much further from the anus, and there is less risk of ascending infection.

Cystitis can also occur in a descending way if the patient initially has, for example, pyelonephritis. In third and fourth place in terms of frequency of occurrence, one can name the lymphogenous transmission route, which exists with prolonged, chronic inflammation of the fallopian tubes and ovaries, as well as the direct route, for example, during incorrect installation of a catheter associated with trauma.

Acute cystitis, even if treated, but treated incorrectly, can become chronic. This can be facilitated by the presence of a chronic specific infection that is sexually transmitted, such as trichomoniasis or gonorrhea. Usually cystitis is caused by chlamydia, staphylococci, E. coli, various mycoplasmas. And in the event that a person has a state of reduced immunity: due to the presence of diabetes mellitus, HIV infection, then the chance to cure simple acute cystitis radically, with recovery, drops significantly. That is why it is necessary to immediately consult a doctor, and not self-medicate, and take the most potent drugs on your own, without determining the pathogen and developing a rational strategy and tactics of treatment.

Symptoms and signs

Recall the main symptoms and signs characteristic of acute cystitis, or exacerbation of a chronic disease:

1. frequent urination, more than 5 times a day;

2. unpleasant pain and cramps during or before urination;

3. rather strong urges, after which a surprisingly small amount of urine comes out;

4. quite often the patient wakes up at night with a strong desire to empty the bladder;

5. common manifestations are possible – such as subfebrile temperature, without any signs of a cold, catarrhal phenomena and pronounced symptoms of intoxication;

6. cloudy urine;

7. aching and pulling pains in the lower abdomen, in the suprapubic region;

8. after the act of urination, a terminal drop of blood appears, or terminal hematuria;

9. discharge of mucus and pus from the urethra.

Of course, most often the last signs are noticeable to men, for obvious reasons, and a different posture during urination. Women cannot notice blood in the urine for quite a long time, especially if it is excreted in the form of 1-2 drops and does not change the color of the total volume of urine.

If there is a “bouquet” in the form of an exacerbation of chronic pyelonephritis, especially against the background of urolithiasis, then this may be accompanied by pulling pains in the lower back, or even symptoms of renal colic. All this together causes understandable nervousness, anxiety and excitement. Sleep, appetite and quality of life deteriorate. How does modern medicine treat acute inflammatory diseases of the urinary tract in general, and cystitis in particular? Consider modern drugs that differ significantly from drugs even at the end of the XNUMXth century.

Pharmacotherapy of acute and chronic cystitis

By the end of the second decade of the XNUMXst century, there are about half a thousand different antibacterial and antimicrobial agents and antibiotics on the pharmaceutical market that can be used to treat urinary tract infections and cystitis. But, in order not to get confused in this abundance of drugs, you must follow the standard scheme:

1. first you need to make sure that there is no specific infection, for example, trichomoniasis or an acute gonococcal process;

2. analyzes are necessarily taken, and if you work “the old fashioned way”, then bacterial culture is performed, both urine and discharge from the walls of the urethra;

3. only after that it is possible to identify the sensitivity of microorganisms to antibiotics and prescribe not empirical, but rational, “targeted” therapy;

4. PCR diagnostics can also be used, but it will be, albeit fast, but qualitative, not quantitative, and cannot show the degree of contamination by one or another type of microorganism in the urinary tract mucosa. But on the other hand, the presence of pathogenic strains can allow, in the study of PCR, to quickly begin the first stage of treatment, namely, empirical drug therapy;

5. after waiting for the final results of sowing and determining the sensitivity of the pathogen to antibiotics, proceed to a rational treatment regimen, making certain adjustments to the treatment regimen.

In this review of drugs for cystitis, we will limit ourselves to modern antibacterial drugs. This list will not include immunomodulating drugs, antifungal drugs, which are sometimes included in complex therapy. Also, the treatment of comorbidity and the elimination of risk factors, for example, hormonal drugs, which are sometimes prescribed for cystitis in the postmenopausal period, will not be considered here.

In the list, drugs for cystitis are divided into groups according to the ATC classification. Mostly original drugs are provided, which have proven their high efficiency. However, in brackets after the name of the original drug, there are some commercial copies sold in Russia, or generics, which are always sold cheaper. For each drug, the INN, or international non-proprietary name, is first given, and the range of prices is given, relevant for the end of March 2020, for pharmacies of all forms of ownership in the Russian Federation.

Medicines included in this review, as well as not included in it for any reason, are present or absent in the article not for reasons of advertising or personal interests of the author, but in connection with national and international clinical guidelines for the treatment of cystitis and inflammatory diseases of the urinary tract . And we begin the journey of remedies for cystitis with highly effective drugs from the group of fluoroquinolones.

Rating of the best remedies for cystitis

Best Fluoroquinolones

Medicines from the group of fluorinated quinolones have been actively used in the treatment of urological infections in general, and cystitis in particular, since the early 90s of the XX century, and at the moment there are already several generations of these drugs. The common advantage of this group of drugs is the presence of a tablet form, and there is no need to give intramuscular or even intravenous injections, as is the case with some antibiotics. However, some fluoroquinolones also have parenteral forms of administration, that is, they can be used in the form of injections. And this is very important in case of a severe course during treatment in a hospital. The attending physician has a large arsenal of fluoroquinolones, and using the means of the 3rd and 4th generations of these drugs, one can create a rather high therapeutic concentration in organs and tissues.

Fluoroquinolones penetrate the blood and tissues with great ability, and modern fluoroquinolones still have a long half-life, which can even reach 18 hours. This allows them to be used once a day, which is very convenient for the patient, and gives him a significant adherence to treatment. Usually, the maximum daily dose is immediately prescribed, which can overcome the pathogen, which will be protected by its own resistance mechanisms, fortunately still imperfect.

Fluoroquinolones have a common ability to cause negative reactions from the connective tissue, such as joint pain, tendonitis, tendon pathology, so it is necessary to immediately stop taking the drug if symptoms of adverse reactions, arthralgia appear.

Levofloxacin (Tavanik, Glevo, Levotek, Remedia, Signicef, Flexid, Floracid, Ecolevid)

Rating: 4.9

Tavanic, which is produced by the French company Sanofi Aventis, is a modern and highly effective medicine for cystitis, a third-generation drug. It is not cheap: for one pack of 10 tablets of 500 mg each in March 2020 in a large city in Russia, you will give, on average, from 750 to 890 rubles, but, as they say, “it’s worth it.”

Tavanic treats such serious diseases, in addition to urinary tract infections, cystitis and chronic prostatitis, as anthrax and tuberculosis, severe hospital pneumonia and infections of the skin and subcutaneous tissue. Even such severe kidney damage as tubulointerstitial nephritis sometimes requires its use.

According to the mechanism of action, levofloxacin in every possible way “harms” the nucleic acids of microorganisms, blocks special enzymes, disrupts the spiralization of microbial DNA, and ultimately destroys both the cytoplasm and their cell wall. This drug can be successfully used as a first-line empirical therapy, since many microbes are sensitive to it. These are gram-positive and gram-negative aerobes, including enterococci, staphylococci, including those producing beta-lactamase, anaerobes, chlamydia, mycoplasmas. Of course, sooner or later, as a result, microorganisms can acquire resistance to levofloxacin when they get rid of those two enzymes that this drug acts on, but this requires sufficient time to pass.

How to use Tavanic for cystitis? In acute uncomplicated cystitis or urethritis, it is advisable to use 500 mg of levofloxacin once a day, it quickly penetrates into the cells, and its concentration in the urine increases. In case of severe course, you can increase the dosage – one tablet twice a day. In the case of uncomplicated urinary tract infections, 1 week of medication is sufficient.

Advantages and disadvantages

Tavanic is a modern drug with a wide spectrum of action: many microbes die, and this allows them to start treating cystitis without waiting for the results of bacterial culture, that is, immediately after taking the test. This drug is well tolerated, but there are a number of contraindications: this is epilepsy, age up to 18 years, since fluoroquinolones can negatively affect bone growth zones, their cartilaginous points, and therefore fluoroquinolones are not prescribed for pregnant and lactating women.

There is also a special contraindication – this is intolerance to fluoroquinolones in general, leading to damage to the tendons. There are also a number of relative contraindications: increased seizure threshold, electrolyte disturbances, people with diabetes on oral hypoglycemic drugs, and so on. There are also side effects: most often – headache and dizziness, as well as various dyspeptic disorders. It should be especially remembered that if Tavanic is taken together with antacids: Phosphalugel, Maalox, Almagel, then it is necessary to space the intake of these drugs by at least two hours, since aluminum and magnesium reduce the effectiveness of Tavanic.

Moxifloxacin (Avelox, Vigamox, Maxiflox, Moflaxia, Rotomox, Hynemox)

Rating: 4.8

Avelox is also a powerful, modern fluoroquinolone, which is used for rather severe lesions of the urinary tract, and in the case of simple, uncomplicated cystitis, it can be a reserve drug. He is able to treat such severe processes as diabetic ulcers, peritonitis, and complications after surgical interventions. This drug is produced by the Bayer-Schering company from Germany, and one package of Avelox costs even more than Tavanic: for one package of 5 tablets (not 10), 400 mg each, you will have to pay from 550 to 680 rubles.

Avelox also has a characteristic action for all fluoroquinolones, and it affects the synthesis of hereditary bacterial material. Microbes rarely develop resistance to it, and even those who have learned to resist penicillin, cephalosporins, tetracycline and other groups of antibiotics do not affect the effectiveness of Avelox. Yes, resistance to it will still develop, but it will be slow, through various blind mutations of microbes.

Many microorganisms, both gram-positive and gram-negative, as well as many anaerobes, are sensitive to Avelox. Perhaps resistant to Avelox at the moment can be called Staphylococcus aureus, as well as some staphylococci, which do not often cause cystitis, and other urinary tract infections. The drug can also be used for other diseases, such as exacerbation of chronic bronchitis, acute sinusitis, skin infections, and so on. It is necessary to apply it once a day, one tablet for any infections, so the medicine will last for 1 days. However, in the event that we are talking about cystitis or pyelonephritis, then usually the duration of treatment should be at least 5 days. In any case, the duration of treatment for any form of infection should not exceed 10 days.

Advantages and disadvantages

A big plus of Avelox is that neither the doctor nor the patient will have any confusion with the treatment: for any illness, you need to take one tablet once a day. But you need to remember about contraindications. As in the previous case, these are children and young men with a growing skeleton under the age of eighteen, pregnant and lactating women. They are not allowed to use this medicine. Contraindication – and pathology of the tendons, due to the use of fluoroquinolones, which happened earlier, that is, in the anamnesis. And also, these are patients who have a prolongation of the QT interval on the ECG. This is low plasma potassium, a rare number of heartbeats, or bradycardia, as well as various other rhythm disturbances. It is undesirable, or with caution, it is necessary to prescribe Avelox to patients who have had psychosis, who have myasthenia gravis, or cirrhosis of the liver.

Of the side effects, one can name the development of a fungal infection, which is why it is necessary to use the drug in as short courses as possible. Other side effects include dizziness and headache, and in the case of low plasma potassium, prolongation of the corresponding QT interval on the ECG. The drug can also interact with antiarrhythmic drugs, antacids, so only a doctor should prescribe this highly effective drug for cystitis.

Ciprofloxacin (Ciprolet, Ciprinol, Cifran)

Rating: 4.7

Ciprofloxacin has been treating various infections “cheaply and cheerfully” for a long time, since the nineties of the last century. It is cheap, it can be used in uncomplicated cases, when the patient’s immunity is strong, and the infection has appeared for the first time. Ten 500 mg tablets of Indian production by Doctor Reddis will cost no more than 110 rubles. for packing. Ciprolet has the same effect on the microorganism, disrupts the synthesis of DNA and its enzymes, which are responsible for the reproduction of bacterial cells. For warm-blooded animals (and in general, for multicellular animals), it is of low toxicity, since they do not have the same enzymes that microbes have. Gram-negative bacteria are sensitive to it, including chlamydia, various types of gram-positive staphylococci and streptococci.

The drug is inexpensive, and can be used for a variety of infections, so it is desirable in any first aid kit. It is prescribed for sinusitis, cystitis and pyelonephritis, inflammatory diseases of the skin and soft tissues, genital organs, as well as for bacterial complications that have arisen in patients on immunosuppressive therapy. With cystitis, it is taken orally, and in the case of an uncomplicated form of acute cystitis – from half a tablet twice a day, to one tablet twice a day, that is, in a daily dose of 500 to 1000 mg. Uncomplicated cystitis in women requires 500 mg once a day.

Advantages and disadvantages

The advantage of ciprofloxacin is its low price, it is well studied, but the general contraindications remain the same. It should be remembered that there is another drug called Ciprolet A, that is, ciprofloxacin, which is combined with the antifungal drugs tinidazole, and is also produced by the Indian laboratory Dr. Reddis, but this is a different drug and should not be confused. The disadvantage of ciprofloxacin is that its activity is not as high as that of more modern fluoroquinolones, belonging to the latest generations. But still, in the case of a banal, uncomplicated cystitis, along with other drugs, with the use of suppositories intravaginally in women, local antiseptics, immunomodulatory therapy, it will completely cope with the infection.

The best antibiotics

Yet, microbes are becoming resistant to fluoroquinolones too, otherwise there would be no need to continue the search for next-generation drugs from this group. If you constantly use fluoroquinolones already old, well known in severe cases, then the resistance of urinary infection pathogens will gradually increase. By the end of the second decade of the 8st century, this resistance may reach 9-XNUMX% of all cases, so it is necessary either to add other drugs to therapy or to find new ways.

Therefore, in the case of treatment of severe forms of cystitis, atypical flora, or in the presence of concomitant pathology, for example, a sharp suppression of immunity, diabetes mellitus, it is necessary to use drugs from the group of antibiotics. Let’s consider some of them. But it should be immediately clarified that they are all prescribed by a doctor, and since they are all intended for intravenous and intramuscular administration, they are used only in hospitals for the treatment of complicated forms of cystitis and pyelonephritis, and are very rarely prescribed in outpatient practice for home treatment. Consider several antibiotics, ranging from cheap and simple, and ending with the most powerful and modern. In total, in this group we will consider four different drugs, but, of course, there can be much more.

Amikacin (Amikacin, Likacin, Selemicin, Amikin, Farcyclin, Hemacin)

Rating: 4.9

In the treatment of cystitis, it goes under the motto “cheap and cheerful”, and quite often Amikacin is purchased by hospitals for mass prescriptions. This powder, sold in a 1 g vial, is produced by its domestic pharmaceutical plants – Sintez and Krasfarma, and the cost of one vial will be about 70 rubles.

It is a well-known third-generation aminoglycoside, which is extremely widely used to treat septic complications, gonococcal infections, purulent meningitis and otitis media, purulent infections of the biliary tract, soft tissues, infectious arthritis, and so on. Cystitis and pyelonephritis are also included in this list. Along the way, Amikacin is also a reserve anti-tuberculosis antibiotic. Unlike fluoroquinolones, it does not affect DNA – bacterial hereditary material, but on the synthesis of bacterial proteins on ribosomes, destroying the amino acid sequence. The result is the synthesis of defective proteins, and the death of the microbe. Many causative agents of cystitis are sensitive to Amikacin. These are Escherichia coli, Enterobacter, various types of streptococci and staphylococci, including those resistant to gentamicin, netilmicin and tobramycin.

If it is administered at a dose of 1 g once a day intramuscularly, then this will be the normal dosage for the treatment of cystitis, which is accompanied by complications, or there are concomitant symptoms. It is advisable not to increase this concentration, and not to prescribe Amikacin in a higher dosage, since it may have nephrotoxic or ototoxic reactions. In the same case, if we are talking about an elderly person, if cystitis or pyelonephritis is complicated by a hospital infection, then it is necessary to use not only aminoglycosides of the III generation, which is amikacin, but also modern cephalosparins, at least III or IV generation, about which will be discussed further.

Advantages and disadvantages

One of the main contraindications and at the same time complications to the appointment of amikacin and other aminoglycosides is the presence of hearing loss, damage to the auditory and vestibular apparatus, chronic and acute labyrinthitis, as well as severe renal dysfunction, since these antibiotics are otoxic and nephrotoxic. Therefore, it should be used once a day, since this regimen has a lower risk for the development of complications on the auditory nerves. If we are talking about high doses, then in any case, the ototoxic effect of the drug first appears, and then the nephrotoxic effect. Therefore, in no case should it be purchased independently, and it should not be prescribed to pregnant women, but only for health reasons, since it has a harmful effect on the fetus – a deaf baby may be born. When treating with Amikacin, it must be remembered that it is not compatible with penicillins and all cephalosporins. However, I am not talking about combination therapy at all, but about mixing substances in one syringe, or in one infusion system.

Cefotaxime (Klaforan, Kefotex)

Rating: 4.8

Klaforan, or cefotaxime, belongs to the third generation cephalosporins, and is available in 1g vials for intramuscular injection. One such bottle of Claforan manufactured by Sanofi costs, on average, 180 rubles. (single dose). A rather cheap generic will cost 34 rubles. for that package. This antibiotic is bactericidal, that is, it not only stops the growth of bacteria, but also destroys them. It is known that there are antibiotics that only stop the growth of microbes, such as chloramphenicol, but do not destroy them in large quantities.

Many microbes that cause inflammation of the urinary tract are sensitive to cefotaxime, including cystitis, urethritis, and pyelonephritis. However, it is worth knowing that if the infection is caused by a gram-negative anaerobic flora, or acinetobacter, clostridia, bacteroids, which is quite possible in severe immunodeficiencies, then this drug is unlikely to help. Klaforan is used in pulmonology, in the presence of bacterial endocarditis, in the complex therapy of abdominal purulent infections, such as peritonitis, with bone and joint infections. It can also be used as a means of prophylaxis after surgical operations.

It must be administered either intramuscularly or, in severe cases, intravenously. As for gonorrhea, you can generally make just one injection intramuscularly, and this will complete the treatment with antibacterial drugs. If we are talking about a severe form of cystitis, then it will take several days, for example, intramuscularly 1 time per day, and the duration of the course is set by the doctor. The drug is diluted with sterile water, in the amount of 4 ml for a 1 g vial. It is advisable to use a XNUMX% solution of lidocaine, strictly intramuscularly, because the injection with water is quite painful.

Advantages and disadvantages

Klaforan is a worthy alternative to Amikacin, and does not cause ototoxic and nephrotoxic effects. However, if the patient has a significant impairment of kidney function, then the dose is halved, both one-time and daily. The drug is contraindicated in case of sensitivity to cephalosporins, during pregnancy and breastfeeding. The medicine can cause side effects, and if a person has an increased sensitivity to lidocaine, there is an intracardiac blockade, severe heart failure, then it is necessary not to dilute Klaforan on lidocaine.

It is strictly forbidden to mix Klaforan with other antibiotics in the same syringe, including Amikacin. Before prescribing Klaforan, it is necessary to carefully find out if the patient has had allergic reactions, and it should be remembered that in the first weeks of treatment, pseudomembranous colitis can occur as a side effect at a high dose, which will be manifested by severe diarrhea. This is a rather serious complication, in this case, the introduction of Klaforan is immediately stopped and treatment is prescribed.

Meropenem (We will ride)

Rating: 4.7

Meropenem, which belongs to the carbapenems, is still one of the most expensive and “strong antibiotics” widely known to the public. It can be thought of as a backup or last resort for severe meningococcal infections, sepsis, severe microbial meningitis, and severe urinary tract infections. It is used in gynecology, as well as for the treatment of peritonitis.

The drug in vials weighing 1 g in the amount of 10 pieces, in the case of the original British-made Meronem Astrazeneca, will cost you from 9500 rubles. up to 14000 rub. for packing. There are also generics, the cheapest of which starts at a price of 280 rubles. for one bottle, provided the dosage is half as much, that is, 500 mg. A package of the original Meronem with a dosage of 500 mg in the amount of 10 pieces in the spring of 2020 will cost about 5000 rubles. Certainly.

In the case of adult dosages for severe cystitis and other urinary tract infections, Meronem should be administered intravenously at 500 mg every 8 hours, the duration of the course is at the discretion of the attending physician.

Advantages and disadvantages

Why is Meronem so expensive? It has a lot of advantages, of course, it also has contraindications, but there are few of them: hypersensitivity to an antibiotic from the carbapenem group, and children under three months old. This medicine has a wide range of uses, in addition, it is prescribed for children older than 3 months. If necessary, associated with a risk to life, it can also be used in pregnant and lactating mothers. The most common side effects are increased platelets, nausea and diarrhea, often local reactions, such as venous thrombophlebitis at the injection site. However, in patients with hepatic and renal insufficiency, it is not necessary to adjust the dose.

Ceftolosan + tazobactam (Zerbaxa)

Rating: 4.6

Finally, for the curious, we provide a special kind of modern antibiotic. This is ceftolosan, which is a new, fifth generation cephalosporin, combined with sodium tazobactam, that is, two antibiotics in one: a beta-lactamase inhibitor that microorganisms acquired (tazobactam) and a modern cephalosporin. This is a “new thought” in antibiotics, and in the US it has been approved by the FDA since 2014. Its components disrupt the synthesis of the cell wall, and this remedy is necessary in case of seriously complicated intra-abdominal infections with gram-negative flora, as well as streptococcal contamination. It can also be used in the case of complicated, hospital-acquired urinary tract infections caused by Escherichia coli, with urosepsis, the source of which can also be banal cystitis. The drug is prescribed in case of resistance to other antibiotics.

Apply the drug intravenously slowly, for one hour three times a day, every 8 hours. The duration of treatment is determined by the doctor. However, in our setting in the Russian Federation, it is likely that the duration of treatment will determine the possibility of acquiring this drug. It is sold in Russian pharmacies, but since it has only recently been put into operation in the United States, this drug is only imported, appears in small batches, and is designed for severe cases in financially wealthy people and their relatives. So, Zerbaks in the amount of 10 pieces in a package, which is enough in severe cases for 3-4 days of infusion, can be purchased in Moscow, and only on order from 55000 to 80000 rubles.

Why is it necessary to give information about such rare medicines? Yes, simply because the Russian reader still has information about modern drugs, the production of which, including new ones, is carried out abroad. Therefore, for the Zerbax drug, we will not talk about the advantages and disadvantages, this information is provided for review. However, the drug is very powerful, can be used for violations of liver function, and it is contraindicated in case of hypersensitivity to cephalosporins and beta-lactams.

The best nitrofurans

Nitrofurans are very widely used on an outpatient basis, since there is an opposite trend here: they do not have parenteral forms for injection, just as there are no tablet forms for the antibiotics discussed above. The task of nitrofurans is completely different: it is the creation of a high, therapeutic concentration not in the tissues, but in the urine, that is, the “cavity” of the urinary tract. Urine acquires a bactericidal effect, and itself becomes detrimental to microorganisms.

The second feature of nitrofurans is the slow growth of resistance to these drugs, the ability to use them for a long time in chronic pathology of the kidneys and bladder. Nitrofurans are proven effective drugs, they are well studied. In the case of a chronic urinary tract infection, many urologists recommend the use of nitrofuran treatment courses as maintenance therapy for 3 to 6 months. When prescribing, it should be remembered that they are quickly excreted from the body, and create the concentration necessary for treatment, only in the urine and intestinal contents. For many years, only furazidin has been used for treatment and specific prophylaxis, but at present, the modern drug nifuratel is also successfully used for the treatment of both acute and recurrent, postcoital cystitis. Therefore, we will consider these two representatives: the old and the new.

Furazidin (Furamag, Furagin)

Rating: 4.9

Usually, domestic, relatively cheap Furagin tablets can be bought for 150-270 rubles, 50 mg No. 30 each. Consider Latvian-made Furamag, Oline Pharm, which costs more: in the same dosage and in the same amount, on average, 700 rubles . It has high efficiency and good tolerance. The drug is used for acute and chronic cystitis, urethritis, as well as if there is a urinary tract infection of unknown location, or an inflammatory process in the female genital organs. As mentioned above, in this case it is needed to create bactericidal concentrations only in the urine, but it can also be used when applied to open wounds, in the case of post-traumatic wound infection. In the case of cystitis, adults need 1-2 tablets 3 times a day to treat an acute process.

Advantages and disadvantages

When appointing Furamag, you need to remember about contraindications. This is chronic renal failure, which occurs in severe form, pregnancy, children under 3 years of age. But at the same time, Furamag is low toxic, causes few side effects that rarely occur, less than 1%. These are nausea, headache and skin rash. It is advisable to drink Furamag with plenty of water to avoid the possibility of side effects, and avoid taking acidifying urine with Furamag, for example, ascorbic acid.

Nifuratel (McMirror)

Rating: 4.8

Macmirror can be considered a modern drug of the nitrofuran series, and it is produced in Italy: 20 tablets of 200 mg each will cost an average of 1000 rubles. It is used for infections of the lower urinary tract: urethritis and cystitis. So, in an acute uncomplicated process, you can give 1-2 tablets 3 times a day, and this dosage is maintained on the first and second days, and in the next three to four days you can limit yourself to a maintenance dose: one tablet three times a day.

Advantages and disadvantages

Macmirror has an excellent effect, in addition to ordinary microorganisms, on chlamydia, candida, mycoplasmas and Trichomonas, that is, on sexually transmitted diseases. Its antitrichomonal activity is generally equal to metronidazole, but at the same time it is still capable of destroying gram-negative and gram-positive microbes. Macmirror is well tolerated, can be administered intravaginally and has very low toxic effects, as well as no harmful effects on the fetus.

However, it must be remembered that it cannot be combined with alcohol, otherwise a teturam-like reaction is possible, and side effects may include various disorders of the gastrointestinal tract. In case of acute cystitis or acute urethritis, 1 week to 10 days of treatment is sufficient. It is very important that Nifuratel can also be prescribed to pregnant women, especially in the treatment of cystitis of trichomonas and candidal etiology. It is important that the drug can be administered intravaginally in the form of suppositories, this complements the complex therapy of cystitis and urethritis.

Herbal remedies: Phytolysin

Rating: 4.7

Finally, in conclusion, consider the popularly beloved herbal preparation called Phytolysin, which is produced in Poland. It is sold in the form of a tube of a special paste, green in color with a characteristic pleasant smell, and costing about 400 rubles. Phytolysin is a herbal diuretic that is indicated for the complex treatment of urinary tract infections. Its composition is complex and varied. These are goldenrod and horsetail, mountaineer and wheatgrass, birch leaves, fenugreek seeds, lovage roots and a set of essential oils: orange, sage, pine and peppermint. Such a sophisticated composition allows you to have an antispasmodic effect, a slight diuretic, and helps to wash out sand and small stones from the urinary tract. It is necessary to use Fitolizin in combination, that is, either with a fluoroquinolone, or with a drug from the nitrofuran group, or together with antibiotics. It is used orally for cystitis, 1 teaspoon in warm water, 3 times a day after meals, the course of treatment is from 2 weeks to month.

Advantages and disadvantages

The drug Fitolizin helps antibacterial agents to cope with the infection, but its main task is symptomatic treatment, pain relief, reduction of dysuric disorders, and improvement of the quality of life. A moderate diuretic effect allows you to eliminate stagnation and remove decay products of microbes from the urinary tract. The drug has a small number of contraindications: these are chronic renal failure, phosphate kidney stones, or phosphate urolithiasis, glomerulonephritis and heart failure. It is better not to take this medicine for pregnant and lactating women, not because it is harmful, but because the relevant studies have not been conducted.

Conclusion

We reviewed some representatives, mainly antibacterial drugs used in the treatment of acute chronic cystitis, urethritis and pyelonephritis. Naturally, in complex treatment, a urologist or infectious disease specialist prescribes other means that affect not only the immediate cause of the disease, that is, pathogenic pathogens, but also on individual stages of the pathological process. So, non-steroidal anti-inflammatory drugs (NSAIDs), which can be used in suppositories, improve well-being, reduce pain and reduce the severity of dysuric disorders. These are Ketonal (ketoprofen), indomethacin or Voltaren suppositories, it is better to prescribe them at bedtime.

In some cases, especially in postmenopausal women, drugs are used to treat urinary incontinence, including those from the category of anticholinergics, but this has been described in detail in the corresponding article on incontinence, or urinary incontinence.

But, when conducting outpatient treatment of acute and chronic cystitis, it is necessary to be firmly aware of when hospitalization and intramuscular or intravenous administration of the drug is necessary. This is the failure of outpatient therapy for 3 days (when complaints persist or increase), signs of an acute, ascending infection, severe immunodeficiency, HIV infection, concomitant use of immunosuppressants, or severe diabetes mellitus.

Requires mandatory hospitalization for a condition with impaired urodynamics, obstructive processes, or acute urinary retention. It is impossible to treat on an outpatient basis and resistant, caused by microbial association, recurrent infectious process, as well as accompanied by severe symptoms, such as hematuria, or severe pain. In addition, it is necessary to hospitalize pregnant women in the presence of acute cystitis of any etiology.

Attention! This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.