Опыт применения антибактериального препарата Фосфомицин Эспарма при лечении острого неосложненного цистита у женщин

Japanese guideline for clinical research of antimicrobial agents on urogenital infections: Second edition.

Standardized Care Pathway (SCP) for patients presenting with macroscopic haematuria was introduced in Sweden in 2015. In contrast to neighbouring countries, the Swedish model includes all patients with macroscopic haematuria above the age of 50, notwithstanding obvious causes. The aim of this study was to characterize the patients referred within the SCP and the presence of acute cystitis. All patients admitted to two regional hospitals in 2023, under the terms of SCP macroscopic haematuria, were included. Patient data were collected retrospectively regarding age, sex, symptoms of cystitis and cause of haematuria. The study included 782 patients. The median age was 70 years and half were women. In 89 cases, a urinary tract cancer was found (11%) and 74 (9%) had bladder cancer. The cancer-positive group was significantly older (median 75 years) and 76% were men. Half of patients (51%) had symptoms of acute cystitis on referral. This was significantly associated with the absence of bladder cancer, but only in the age groups 50-69, where no case was found among patients with symptoms of cystitis. In the age groups above, 22 cancer-positive patients (30% of all bladder cancer cases) had symptoms of cystitis. The Swedish SCP macroscopic haematuria targets younger female patients unproportionally, in comparison to where cancer is likely found. Neither symptoms of cystitis, nor positive urine cultures exclude bladder cancer in elderly, but clearly in the age groups 50-69. If excluding the latter from the SCP, a 28% reduction of examined patients can be achieved with a negligible risk of missing cancer.

To explore the antibiotic prescribing pattern for cystitis and the patient-related variables associated with prescription during a 4 year period among Italian general practitioners (GPs). We obtained information from the 'Health Search Database' (HSD), an Italian general practice research database. From a total sample of 457 672 eligible patients aged >16 years registered up to December 2002, we included those whose diagnoses could be classified as acute (uncomplicated and complicated) and recurrent cystitis. Patients' features and prevalence of antibiotic users were assessed. Of 35 129 cases diagnosed during the period 1999-2002, 96.0% of them were acute cystitis (39.2% recorded as uncomplicated). The prevalence of cases with acute complicated and uncomplicated cystitis slightly increased during the 4 year period, whereas it remained stable for recurrent cystitis. Most of the cystitis cases reported no diagnostic tests. More than 70% of patients were prescribed with at least one antibiotic, with a 4-fold increased risk of antibiotic use for acute cystitis throughout the study period. The prevalence of antibiotic users reached 86.2% for both acute uncomplicated and complicated cystitis in 2002, and 81.5% for recurrent cystitis. Fluoroquinolones represented the most common antibiotics being prescribed although they markedly decreased during these years. Fosfomycin trometamol use increased dramatically, becoming the first choice for any type of cystitis. Data indicate an evident rise in antibiotic use mostly related to fosfomycin trometamol. They also indicate that such a prescriptive trend finds confirmation from the available evidence for acute uncomplicated cystitis, although the management of recurrent cystitis could be further improved.

The World Health Organization has recommended herbal medicine for treatment and control of recurrent cystitis. This study was conducted to determine effect of eshnan on the prevention of recurrent cystitis. The present triple-blind clinical trial was conducted on 126 women (63 women per group) with recurrent cystitis. The participants were assigned to the intervention and control groups. Three 500-mg eshnan or placebo tablets were taken orally with a glass full of water by the participants half an hour after each meal for 2 months. The study subjects were clinically and paraclinically evaluated by the end of the second, fourth, and sixth months after the intervention and every time they showed clinical symptoms of cystitis. The present findings showed that the incidence rate of cystitis and symptoms of cystitis was significantly lower in the eshnan group compared with the placebo group 2, 4, and 6 months after the intervention (p < .05). The incidence of recurrent was also significantly lower in the intervention group compared with the control group (p < .001). No side effects were observed in the intervention and control groups. The consumption of eshnan can improve the symptoms of cystitis and prevent the incidence of recurrent cystitis in women of reproductive age.

MANAGEMENT OF URINARY TRACT INFECTIONS: HISTORICAL PERSPECTIVE AND CURRENT STRATEGIES: PART 2— MODERN MANAGEMENT

Urinary tract infections during pregnancy are associated with severe complications. Earlier initiation of antibiotic treatment for acute uncomplicated cystitis, reduces the various complications.Objective. To assess the effectiveness of fosfomycin in the treatment of acute uncomplicated cystitis during II and III trimester of pregnancy.Material and methods. The study included 74 pregnant women who had acute uncomplicated cystitis in II or III trimesters. All patients received fosfomycin trometamol 3.754 g (equivalent to 3 g fosfomycin) as antimicrobial therapy for acute uncomplicated cystitis. The drug was prescribed to 24 pregnant women in the II, and 50 in the III trimester of pregnancy.Results. After treatment with fosfomycin signs of acute cystitis gone in all patients. At the same time, regression of clinical symptoms was noted during the next days after therapy in 95.9% (n = 71) of cases. Repeated microbiological test of the middle portion of urine was performed 7 days after the end of antibiotic therapy. In 94.6% (n = 70) cases, total elimination of the pathogen was achieved. In 5.4% (n = 4) cases, there was a significant decrease of colonization Follow-up for three months showed the absence of recurrence of acute cystitis in all pregnant women who were included in the study.Conclusion. Fosfomycin is a highly effective drug in the treatment of uncomplicated cystitis during pregnancy.

Urinary tract infections (UTIs) are defined as the symptomatic presence of pathogens in the urinary tract that are typically diagnosed by microscopy and culture of urine samples. Over the long-term antibiotic courses, alternative prophylactic methods as probiotics, cranberry juices and D-mannose have been introduced for recurrence prevention. The present study aimed to determine whether a new combination of D-Mannose, Pomegranate extract, Prebiotics and Probiotics is effective in modifying symptoms reported by women with acute uncomplicated acute cystitis. This is a pilot study, performed between September 2018 and November 2018 at the Department of Urology of Villa Stuart Private Hospital. A dose of a new combination of agents was administered twice daily for 5 days and then once a day for 10 days. Together with the compound, forced hydration (> 2 liters/day) has been strongly suggested. Antibiotics were permitted only in case of clinical worsening. Changes in patients' symptoms, the therapeutic effects and changes in quality of life (QoL) were evaluated clinically and through a validated questionnaire, the Acute Cystitis Symptom Score (ACSS) at the first visit (T0), 15 (T1) and 30 (T2) days later. Thirty-three patients were enrolled in the study (mean age 38,1 ± 11.2 years) and all completed the treatment protocol. At T1 visit, all symptoms or the majority of symptoms went off in 10 women (30.3%) and at T2 in 30 women (90.9%); some symptoms still remained in 16 women (48.5%) at T1 and in 3 women (9.1%) at T2; the persistence of all symptoms or the worsening of the condition was observed in 7 patients (21.2%) at T1 and in none at T2. The mean score reported at all the ACSS sub-scales significantly decreased between baseline and T1 and T2. Typical symptoms decreased from 11.5 (10.5-12.6) to 4.9 (4.0-5.9) and to 2.7 (2.1-3.3) (p-values < 0.0001); differential symptoms decreased from 3.1 (2.6-3.6) to 0.6 (0.3-0.9) and to 0.3 (0.1-0.5) (p-values 0.009 to < 0.0001); QoL mean score also decrease from 7.2 (6.7- 7.7) to 4.0 (3.3-4.6) and to 1.7 (1.2-2.1) (p-values < 0.0001). Six patients required antibiotics and no adverse events were recorded. Our study suggests that the action of the compounds, administered in this new combination, could help in an effective management of symptoms of acute cystitis in women, without antibiotics, in a wide majority of the cases. Lack of microbiological assessment is a clear limitation of the study. Moreover, lack of a control group is another important limitation. Finally, hyperhydration could have been a confounding factor in interpretation of results.

Anemia is a critical global public health issue, especially among women of reproductive age (15-49 years) in low- and middle-income countries. Mozambique has the highest prevalence of anemia in women of reproductive age in Sub Saharan Africa in 2019. This study aims to assess the spatial variation and predictors of anemia among women of reproductive age in Mozambique. Individual record and spatial coordinates data from the Mozambique Demographic and Health Survey (DHS 2022/23) were used. A stratified two-stage cluster sampling method was applied. Global autocorrelation analysis was performed to determine clustering of anemia. A weighted sample of 5,907 women of reproductive age was analyzed using ArcGIS 10.7. Multiscale geographically weighted regression was employed to identify predictors of anemia. The national prevalence of anemia among women of reproductive age in Mozambique was 51.89% (95% CI: 50.66, 53.12%). Higher rates were observed in Nampula, Zambezia, and Sofala. Unimproved drinking water, pregnancy, and being underweight were positively correlated with anemia, while contraceptive use and obesity were negatively correlated. Geographic variability in these associations was evident (Global Moran's I = 0.0.444359 and p < 0.001). Anemia was the highest in Tete and Manica due to unimproved drinking water the effect of pregnancy on anemia was significant in Manica and Sofala. Being underweight was strongly related to anemia in Niassa. Conversely, contraceptive use and obesity had a protective effect in Nampula, Zambezia, Niassa, and Cabo Delgado. Anemia remains a critical public health issue among women of reproductive age in Mozambique, with marked regional disparities. Hotspot clusters were identified in Nampula, Zambezia, Tete, and Sofala. Factors such as unimproved drinking water, pregnancy, and being underweight were associated with higher anemia rates in certain regions, while obesity and contraceptive use indicated a protective effect in specific provinces. To effectively combat anemia, policymakers should focus on improving access to clean water and maternal health services, and enhancing nutritional support through the USAID Advancing Nutrition Project, the Global Alliance for Improved Nutrition, Integrated Community Case Management, and Supervised Weekly Iron and Folic Acid Supplementation.

Введение. Цистит является одной из наиболее часто встречающихся инфекций мочевыводящих путей, подвергающихся терапии в амбулаторных условиях. В России ежегодно регистрируют до 36 млн случаев заболевания. Основным возбудителем неосложненного цистита, выявляемым в 75% случаев, является Е. coli, в оставшихся этиологическими агентами являются S. saprophyticus, Klebsiella spp. и ряд энтеробактерий, крайне редко – анаэробные микроорганизмы, хламидии и уреаплазма. В статье рассмотрены предрасполагающие факторы и патогенез острого неосложненного цистита. Результаты. Целью лечения острого неосложненного цистита является быстрая эрадикация возбудителя, приводящая к клиническому и микробиологическому выздоровлению, а также профилактика рецидивов заболевания. Неосложненный острый цистит в большинстве случаев лечится в амбулаторных условиях. Основу фармакотерапии острого цистита составляют антибактериальные препараты. Назначение антибактериального препарата осуществляется эмпирически при выявлении симптомов заболевания с учетом предполагаемой этиологии цистита и клинико-фармакологической характеристики препарата при обязательном учете современного состояния антибиотикорезистентности. Оптимальный выбор препарата и режима антибиотикотерапии способствует более быстрому выздоровлению и снижению риска хронизации заболевания. Заключение. В статье представлена подробная информация о существующих режимах антибиотикотерапии острого цистита, а также основные показания к назначению антибактериальных препаратов. Проанализированы результаты исследований эффективности препарата цефиксим в терапии острого неосложненного цистита, включая цистит беременных. Background. Cystitis is one of the most common urinary tract infections undergoing treatment on an outpatient basis. In Russia, up to 36 million cases of the disease are registered annually. The main causative agent of uncomplicated cystitis, detected in 75% of cases, is E. coli, in the remaining cases, the etiological agents are S. saprophyticus, Klebsiella spp. and a number of enterobacteria, extremely rare – anaerobic microorganisms, chlamydia and ureaplasma. The article discusses predisposing factors and the pathogenesis of acute uncomplicated cystitis. Results. The aim of treatment of acute uncomplicated cystitis is rapid eradication of the pathogen, leading to clinical and microbiological recovery, as well as prevention of relapses of the disease. Uncomplicated acute cystitis in most cases is treated in outpatient settings. The basis of pharmacotherapy of acute cystitis is antibacterial drugs. The appointment of an antibacterial drug is carried out empirically when the symptoms of the disease are detected, taking into account the alleged etiology of cystitis and the clinical and pharmacological characteristics of the drug, with mandatory consideration of the current state of antibiotic resistance. The optimal choice of the drug and the antibiotic therapy regimen contributes to a faster recovery and a reduction in the risk of chronic disease. Conclusion. Detailed information about the existing regimens of antibiotic therapy for acute cystitis is presented in the article, as well as the main indications for the appointment of antibacterial drugs. The results of studies on the effectiveness of the drug cefixime in the treatment of acute uncomplicated cystitis, including the cystitis of pregnant women, are analyzed.

BackgroundAcute uncomplicated cystitis (AUC) is a common ailment in the urological setting. Guidelines for urinary tract infections are based on large-scale multi-centre, epidemiological and international studies. The objective of this observational study was to establish whether the results of a multi-centre study on the resistance profile of Escherichia coli (E. coli) in patients with AUC could be directly applied to an urological practice in a major European city or whether there are divergences in the resistance profile.MethodsAn observational study was applied prospectively to 502 patients with AUC between January 2015 and January 2017). Personal data were anonymised. Exclusion criteria were the patient’s age (<18) and treatment with an antibiotic in the week preceding examination.ResultsThe average age was 32 (range 18–56). The most commonly detected bacteria was E. coli with 86%, followed by Enterococcus faecalis with 10% and Klebsiella pneumoniae with 4%. Resistance tests showed E. coli to be highly sensitive to fosfomycin (99.2%), nitrofurantoin (98.1%) and cefpodoxime (92.9%). E. coli exhibited resistance to ciprofloxacin (CIP) in 15.1%, to trimethoprim/sulfamethoxazole (TRS) in 25.2% and to amoxicillin/clavulanic acid (AMC) in 34% of cases.ConclusionThe comparison between data from this study and data from a multi-centre European (ECO-SENSI, ECO-SENSII and the 2014 update) showed relatively good sensitivity rates for fosfomycin and nitrofurantoin but significant differences in respect of resistance levels to TRS, CIP and AMC. AUC should therefore only be treated with TRS, CIP and AMC after a susceptibility test has been carried out.

PurposeThe purpose of this study is to compare the accuracy of two commonly used questionnaires in diagnosing acute cystitis, i.e., the urinary tract infection symptom assessment (UTISA) and the acute cystitis symptom score (ACSS) questionnaires.Materials and MethodsFrom April 2021 to December 2022, we enrolled female patients with suspected symptoms of acute cystitis as the patient group. As a control group, we included asymptomatic females who came to the hospital for health check-ups. We calculated the accuracy of the two questionnaires in diagnosing acute cystitis and compared the difference in the area under the curve (AUC) of the two through the DeLong test.ResultsA total of 89 and 43 participants were recruited for the patient and control groups, respectively. Both questionnaires include six symptoms: frequency, urgency, dysuria, incomplete bladder emptying, lower abdominal pain, and hematuria to diagnose acute cystitis. However, UTISA includes lower back pain as the 7th symptom. The sensitivity, specificity, and AUC of UTISA and ACSS were 85.4% versus 75.3% (p=0.091), 93.0% versus 93.0% (p>0.999), and 0.96 (95% CI 0.92–0.99) versus 0.90 (95% CI 0.83–0.94) (p<0.001), respectively.ConclusionsUTISA questionnaire demonstrates higher diagnostic accuracy compared to ACSS questionnaire. ACSS has lower sensitivity probably due to its limited assessment of low back pain and the objective definition of the severity of frequency that prevents patients from responding based on subjective severity.

ObjectivesWe aimed to prospectively compare lower urinary tract symptoms in premenopausal and postmenopausal women with acute uncomplicated cystitis before and after antibiotic therapy.Materials and methodsThis study included adult women with acute uncomplicated cystitis who visited 4 institutions between 2019 and 2020. After registration, we administered oral antibiotics and prospectively documented the changes in lower urinary tract symptoms from the first visit to a follow-up visit at 1 week using the Core Lower Urinary Tract Symptoms Score (CLSS) questionnaire.ResultsAfter treatment, pyuria disappeared in 60 of the 66 patients (14 premenopausal and 46 postmenopausal). The CLSS total score (range) changed from 13 (3–29) to 4 (0–18) with a significant improvement in all CLSS items. At baseline, nocturia, urgency, and urgency incontinence were more prominent in postmenopausal women than in premenopausal women. In contrast, baseline urethral pain and quality of life index were more severe in premenopausal women than in postmenopausal women. After treatment, the CLSS total score was still higher in postmenopausal women, as reflected by the relatively higher scores for nocturia and urgency, irrespective of the comparable scores for urethral pain and the quality of life index in the 2 groups.ConclusionsOur results suggest that if storage symptoms persist, they should be carefully interpreted according to menopausal status.

BackgroundDue to the increased magnitude of overweight/obesity in many countries, the World Health Organization (WHO) has identified it as a significant public health crisis, particularly affecting women of reproductive age in developing nations. Despite obesity/overweight among women of reproductive age being widely acknowledged as a pressing public health issue, there has been limited investigation into its pooled prevalence and various associated factors in low and middle-income countries (LMICs) with high maternal mortality. Thus, the objective of our study was to assess the pooled prevalence and associated factors of overweight/obesity among reproductive-age women in low and middle-income countries with high maternal mortality.MethodsWe analyzed secondary data using recent Demographic and Health Survey datasets from 21 low and middle-income countries with high maternal mortality. A weighted sample of 64,076 women of reproductive age was included in the analysis. The variables were extracted from the IR file, and the data were cleaned, recoded, and analyzed using STATA version 14.2 software. A multilevel binary logistic regression model was applied, and adjusted odds ratios (AOR) with 95% confidence intervals and a p-value of ≤ 0.05 were used to identify statistically significant associated factors. Model fitness and comparison were assessed using the ICC, MOR, PCV, and deviance (−2LLR).ResultIn this study, the pooled prevalence of overweight/obesity among women of reproductive age was 32% (95% CI: 27% − 37%), with a significant variation between countries, ranging from 10% in Burundi to 53% in Mauritania. Women of reproductive age with overweight/obesity showed a significant positive association with various factors compared to those with a normal BMI. Accordingly, women’s age, women’s educational status, women’s occupation, women’s marital status, households’ income levels, number of living children, frequency of watching television, using the internet, sex of household head, and sources of drinking water were identified as individual-level factors. On the other hand, residence, community poverty, and community-level media usage were found to be significantly associated with community-level variables.Conclusions and recommendationsMore than three out of ten women of reproductive age were overweight/obese in low and middle-income countries with high maternal mortality. Individual-level and community-level factors were associated with overweight/obesity. Special attention is recommended to older women, those with formal education, non-working women, individuals who spend time watching television and using the internet, urban residents, and female household heads. Furthermore, since higher household income is associated with an increased likelihood of weight gain, it is important to provide appropriate health interventions for women from the wealthiest households.

SummaryBackgroundThe London Summit on Family Planning in 2012 inspired the Family Planning 2020 (FP2020) initiative and the 120×20 goal of having an additional 120 million women and adolescent girls become users of modern contraceptives in 69 of the world's poorest countries by the year 2020. Working towards achieving 120 × 20 is crucial for ultimately achieving the Sustainable Development Goals of universal access and satisfying demand for reproductive health. Thus, a performance assessment is required to determine countries' progress.MethodsAn updated version of the Family Planning Estimation Tool (FPET) was used to construct estimates and projections of the modern contraceptive prevalence rate (mCPR), unmet need for, and demand satisfied with modern methods of contraception among women of reproductive age who are married or in a union in the focus countries of the FP2020 initiative. We assessed current levels of family planning indicators and changes between 2012 and 2017. A counterfactual analysis was used to assess if recent levels of mCPR exceeded pre-FP2020 expectations.FindingsIn 2017, the mCPR among women of reproductive age who are married or in a union in the FP2020 focus countries was 45·7% (95% uncertainty interval [UI] 42·4–49·1), unmet need for modern methods was 21·6% (19·7–23·9), and the demand satisfied with modern methods was 67·9% (64·4–71·1). Between 2012 and 2017 the number of women of reproductive age who are married or in a union who use modern methods increased by 28·8 million (95% UI 5·8–52·5). At the regional level, Asia has seen the mCPR among women of reproductive age who are married or in a union grow from 51·0% (95% UI 48·5–53·4) to 51·8% (47·3–56·5) between 2012 and 2017, which is slow growth, particularly when compared with a change from 23·9% (22·9–25·0) to 28·5% (26·8–30·2) across Africa. At the country level, based on a counterfactual analysis, we found that 61% of the countries that have made a commitment to FP2020 exceeded pre-FP2020 expectations for modern contraceptive use. Country success stories include rapid increases in Kenya, Mozambique, Malawi, Lesotho, Sierra Leone, Liberia, and Chad relative to what was expected in 2012.InterpretationWhereas the estimate of additional users up to 2017 for women of reproductive age who are married or in a union would suggest that the 120 × 20 goal for all women is overly ambitious, the aggregate outcomes mask the diversity in progress at the country level. We identified countries with accelerated progress, that provide inspiration and guidance on how to increase the use of family planning and inform future efforts, especially in countries where progress has been poor.FundingThe Bill & Melinda Gates Foundation, through grant support to the University of Massachusetts Amherst and Avenir Health.

The objective: to study features of gestational dynamics of levels of toxic elements in serum and erythrocytes of women of all reproductive age give birth first time. Patients and methods. Detection of toxic ME conducted in serum and erythrocytes of pregnant women of early, middle and high reproductive age who gave birth for the first time. Reproductive age of pregnant women was 16.33±0.21 years, 24.67±0.37 and 36.14±0.77 years. The study was conducted in the first, second and third trimesters of pregnancy at 10.26±0.34, 23.23±0.51 and 36.08±0.59 weeks of gestation. Content of ME (chromium, nickel, lead, cadmium) in biological substrates was determined by atomic absorption spectrophotometer C-115 MI equipped computer console for automatic calculation of ME content production Selmi (Ukraine). Results. In pregnant women of middle reproductive age changing of contents of toxic microelements were different - serum level of nickel and chromium significantly decreased, its associated with a significant deterioration of the placental barrier against them in the third trimester of pregnancy and transporting them to the fetus. Increased serum lead opposite rising due to the ability of the placenta blocking its active transport. In the blood of pregnant women of middle reproductive age was detected extremely toxic cadmium, while its content in serum and erythrocytes has been steady throughout the pregnancy. Comparative analysis of contents and balance of microelements in serum and erythrocytes in women giving birth for the first time, during pregnancy indicates a more unfavorable structure of the contents of toxic elements in women of early reproductive age compared to the women of middle reproductive age. Until the end of the third trimester of pregnancy there is an increasing of content of toxic nickel and lead in red blood cells and in serum – cadmium. In women of older reproductive age compared to the women of middle reproductive observed trend of increasing toxic nickel and cadmium in blood serum and erythrocytes. Conclusions. The perspective is to determine the role of the placenta in protecting the fetus from exposure of toxic elements and its functions – transport, barrier, depositing on toxic trace elements during the gestational process. Key words: toxic elements, pregnant women, reproductive age, first birth.