No approved-drug candidate for cystitis is corroborated in the literature DeepSearch retrieved. Some conditions are managed with non-pharmacological care — a device, surgery or physical therapy — rather than a medicine; that may be the case here, or the literature we found may simply be too sparse yet to support a drug-repurposing angle.
RCSB Protein Data Bank · entry 9U5A · 2.98 Å · ligand 17-oxoandrost-5-en-3beta-yl hydrogen sulfate (ZWY). Experimental structure, not a prediction.
A 1987 review states that conservative treatment should be satisfactory for 90 per cent of patients with interstitial cystitis. For the remaining patients with severe refractory symptoms, surgical options are considered only after symptoms have usually been present for at least three years. If bladder capacity under general anaesthetic is greater than 400 ml and the main symptom is bladder pain, denervation by cystolysis may be considered. If bladder capacity is less than 400 ml, supratrigonal cystectomy and substitution colocystoplasty is described as the treatment of choice.
A 2020 multicentre double-blind randomised placebo-controlled study of phenazopyridine in 60 women with acute uncomplicated cystitis found that all 30 patients taking a single 200 mg dose reported improvement after six hours, with 43.3 per cent reporting "significant improvement". The severity of general discomfort decreased by 53.4 per cent in the phenazopyridine group compared with 28.8 per cent in the placebo group. Pain during urination decreased by 57.4 versus 35.9 per cent, and frequency of urination decreased by 39.6 versus 27.6 per cent. The time to complete absence of general discomfort was significantly shorter in the phenazopyridine group. No serious adverse events occurred, and the rate of adverse events was comparable between groups. The authors conclude phenazopyridine is effective for symptomatic therapy in acute uncomplicated cystitis and can be recommended in addition to antibiotic therapy.
A 2024 prospective comparative randomised study of 120 patients with chronic cystitis compared a biologically active complex called Cystalis® D Plus against fosfomycin trometamol, with and without NSAIDs. All groups showed a significant decrease in pain intensity by the third day, a significant decrease in symptoms on the Acute Cystitis Symptom Score scale, a decrease in urine leukocytes, and a decrease in microbial load. The authors state that all positive changes were comparable between groups and that Cystalis® D Plus leads to rapid relief of symptoms in recurrent cystitis both as monotherapy and in combination with other drugs.
What is still missing is a clear understanding of which patients with chronic cystitis might benefit from non-antibiotic approaches versus standard antibiotics, and whether the comparable short-term results reported for Cystalis® D Plus hold up in larger, independently funded trials with longer follow-up and harder endpoints such as time to next relapse. The 1987 surgical review is decades old and does not reflect modern minimally invasive techniques or patient selection criteria. No trial has yet stratified patients by urodynamic findings, microbiome status, or pain phenotype to guide treatment choice.
Retrieved by DeepSearch across 234,678,978 indexed works and resolved on OpenAlex — ranked by citations, including the results that did not work.
The Journal of Urology · 2004 · 120 citations
LONG-TERM OUTCOME OF PATIENTS WITH INTERSTITIAL CYSTITIS TREATED WITH LOW DOSE CYCLOSPORINE A
AbstractPURPOSE: We evaluated patients with interstitial cystitis who had been on cyclosporine A treatment for at least a year. Symptom improvement on micturition charts and subjective expression of bladder pain were recorded. Side effects and safety of medication were evaluated. MATERIALS AND METHODS: A total of 23 patients (20 females and 3 males) fulfilling National Institute for Diabetes and Digestive and Kidney Diseases criteria of interstitial cystitis were included in this study. Age of patients at followup was 65.7 +/- 7.6 years (mean +/- SD). Mean followup was 60.8 +/- 35.7 months. Before starting cyclosporine A treatment multiple first line therapies had been tried without clinical help. RESULTS: The number of voidings in 24 hours was 20.8 +/- 6.3 before treatment. After a year of cyclosporine A treatment it was decreased to 10.2 +/- 3.8 (p < 0.001). Maximal bladder capacity increased from 161.8 +/- 74.6 to 360.7 +/- 99.3 ml in a year (p < 0.001). Mean voided volume increased from 101.4 +/- 42.7 to 246.4 +/- 97.9 ml (p < 0.001). The effect was maintained throughout followup. Of 23 total patients 20 reported no bladder pain on cyclosporine A treatment and 11 patients stopped treatment due to a good clinical effect. In 9 patients symptoms recurred within months but disappeared again after cyclosporine A treatment was restarted. Side effects of medication were infrequent. CONCLUSIONS: Cyclosporine A treatment was safe and effective in treating interstitial cystitis. The achieved therapeutic effect was maintained in the long term. Cessation of medication led to recurrence of symptoms in most cases.
https://doi.org/10.1097/01.ju.0000125139.91203.7aThe Journal of Infectious Diseases · 1986 · 66 citations
Randomized Study of Single-Dose, Three-Day, and Seven-Day Treatment of Cystitis in Women
AbstractWe evaluated the following five treatment regimens for acute cystitis in nonpregnant women: cefadroxil, 1,000 mg single-dose; cefadroxil, 500 mg twice a day for three days; cefadroxil, 500 mg twice a day for seven days; trimethoprim-sulfamethoxazole (TMP-SMZ), 320-1,600 mg single-dose, and TMP-SMZ, 160-800 mg twice a day for three days. At four weeks after the end of treatment, 25%, 58%, 70%, 65%, and 88% of patients, respectively, remained cured of infection. The results indicated that three-day treatment (1) might improve cure rates (over single-dose), (2) would reduce incidence of relapse (vs. single-dose), and (3) may be as curative as seven-day treatment. The results of the antibody-coated bacteria test did not predict treatment failure or relapse.
https://doi.org/10.1093/infdis/153.2.277The Journal of Urology · 1987 · 37 citations
Surgical Treatment of Interstitial Cystitis: Indications, Techniques, and Results
AbstractConservative treatment should be satisfactory for 90 per cent of patients with interstitial cystitis. When severe symptoms are refractory and constitute a major disability, surgical treatment should be considered. Usually symptoms will have been present for at least three years before operative methods are used. If bladder capacity (general anesthetic) is greater than 400 ml, and the major symptom is bladder pain, denervation by cystolysis may be considered. If bladder capacity (general anesthetic) is less than 400 ml, supratrigonal cystectomy and substitution colocystoplasty is the treatment of choice.
https://doi.org/10.1016/s0022-5347(17)43603-2Atención Primaria · 2022 · 8 citations · open access
Improved management of cystitis in primary care following the implementation of a simple multifaceted intervention
AbstractWe assessed the impact of the implementation of a simple multifaceted intervention aimed at improving management of cystitis in primary care. Quality control before and after study. Primary care centres in Barcelona city provided by the Catalonian Institute of Health. The multifaceted intervention consisted of (1) creation of a group with a leader in each of the primary care centres, out of hours services, sexual and reproductive centres, and home visit service, (2) session on management of cystitis in each centre, (3) result feedback for professionals, and (4) provision of infographics for professionals and patients with urinary tract infections. Interventions started in November 2020 and ended in the summer of 2021. Variation in the prescription of first-line antibiotics, usage of antibiotics, and request for urine cultures before and after this intervention. Training sessions took place in 93% of the centres. The use of first-line therapies cystitis increased by 6.4% after the intervention (95% confidence interval [CI], 5.7–7.1%). The use of nitrofurantoin in recurrent cystitis increased, mainly in out of hours service (8.7%; 95% CI, 5.2–12.2%). Urine cultures were more frequently requested after the intervention for recurrent cystitis in both primary care centres and out of hours services, with a 7.2% increase [95% CI, 5.9–8.5%), but also for uncomplicated urinary tract infections (3.1%; 95% CI, 1.8–4.4%). A low-intensity multifaceted intervention on management of cystitis, with strong institutional support, resulted in a better choice of antibiotic in antibiotic prescribing, but the intervention had less impact on the adequacy of urine cultures. Evaluamos el impacto de una intervención multimodal en la mejora del manejo de las cistitis en atención primaria. Estudio de calidad antes-después. Centros de atención primaria de la ciudad de Barcelona proporcionados por el Institut Català de la Salut. La intervención multimodal consistió en: (1) creación de un grupo de trabajo con líderes en cada uno de los equipos de atención primaria, servicios de urgencias, centros de atención sexual y reproductiva y servicio de atención domiciliaria, (2) sesión formativa sobre el manejo de las infecciones del tracto urinario en cada centro, (3) retorno de resultados a profesionales, y (4) difusión de infografías a profesionales y pacientes. Las intervenciones comenzaron en noviembre de 2020 y finalizaron en verano de 2021. Variación en la prescripción de antibióticos de primera línea, uso de antibióticos y solicitud de urocultivos antes y después de esta intervención. Las sesiones de formación se realizaron en el 93% de los centros. La selección de fármacos de primera línea en cistitis aumentó en un 6,4% después de la intervención (intervalo de confianza [IC] 95%: 5,7-7,1%). El uso de nitrofurantoína en cistitis recurrente aumentó, principalmente en servicios de urgencias (8,7%; IC 95%: 5,2-12,2%). Las solicitudes de urocultivos aumentaron después de la intervención en equipos de atención primaria y servicios de urgencias en cistitis recurrentes (7,2%; IC 95%: 5,9-8,5%), pero también en cistitis simples (3,1%; IC 95%: 1,8-4,4%). Una intervención multimodal de baja intensidad sobre el manejo de las cistitis junto con el apoyo institucional explícito mejoró claramente la selección de antibióticos, pero tuvo menos impacto en la adecuación de los urocultivos.
https://doi.org/10.1016/j.aprim.2022.102493Urologiia · 2020 · 4 citations
Efficiency and safety of phenazopyridine for treatment of uncomplicated urinary tract infection: results of multi-center, randomized, placebo-controlled, clinical study
AbstractAIM: to evaluate the efficiency and safety of phenazopyridine for the treatment of patients with uncomplicated lower urinary tract infection, accompanied by pain. MATERIALS AND METHODS: A multicenter double-blind, randomized, placebo-controlled study with parallel groups to evaluate the efficacy and safety of phenazopyridine in patients with acute uncomplicated cystitis was performed. A total of 60 women were divided into two groups of 30 patients. In the main group (average age 32.6+/-7.4 years) phenazopyridine was prescribed (2 tablets of 100 mg p.o., with a total dose of 200 mg, once). In the control group, patients (mean age 35.53+/-8.79 years) received a placebo according to the same scheme. To evaluate the efficiency of treatment, the severity of the main symptoms 6 hours after taking the drug was analyzed. After that, patients started antibiotic therapy. They were followed-up for the next three days. The tolerance of therapy was evaluated by the presence of adverse events. RESULTS: All 30 patients taking phenazopyridine had an improvement after 6 hours, and the most frequent response was "significant improvement" (43.3%). The responses of patients in the main group significantly (p<0.05) differed from responses of patients in the control group. Six hours after taking phenazopyridine/placebo, the severity of all values according to VAS score, including the degree of general discomfort, pain during urination and increased frequency of urination improved significantly in the main group compared to the control group. The average assessment of general discomfort in the main group decreased by 53.4% in comparison with 28.8% in the control group, while the severity of pain during urination and urination frequency decreased by 57.4 vs. 35.9% and 39.6 vs. 27.6%, respectively. An analysis of the time before the complete absence of the general discomfort was performed. In the main group this period of time was significantly less than in the control group (p<0.05). There were no serious adverse events while taking phenazopyridine. Rate of adverse events was comparable between two groups. CONCLUSION: The results of the study showed that phenazopyridine is an effective and well-tolerated drug for symptomatic therapy in patients with acute uncomplicated cystitis and can be recommended in addition to etiological therapy.
https://doi.org/10.18565/urology.2020.3.15-21Urologiia · 2020 · 2 citations
Systemic enzyme therapy for treatment of women with chronic recurrent bacterial cystitis
AbstractINTRODUCTION: In most cases, treatment of infectious and inflammatory diseases, including lower urinary tract infections, includes antibacterial drugs. However, their efficiency decreases every year. The absence of new groups of antibiotics makes it necessary to develop alternative treatment schemes and methods for improving efficiency of existing drugs. Systemic enzyme therapy is one of the promising directions in the treatment of lower urinary tract infections, which was shown to be effective for treating a number of diseases. AIM: to evaluate the results of complex treatment of women with chronic recurrent bacterial cystitis using a drug for systemic enzyme therapy. MATERIALS AND METHODS: The examination and treatment of 60 women aged 19 to 45 years with an exacerbation of chronic recurrent bacterial cystitis, who were randomly divided into two groups of 30 patients, was performed. In the group 1, patients received standard antibiotic therapy. In the group 2, women additionally received Phlogenzym. An evaluation of the efficiency was carried out on the 1st, 7th and 14th day and included analysis of lower urinary tract symptoms, according to bladder diaries, assessment of pain intensity and laboratory tests (C-reactive protein [CRP], IL-6, IL-1, TNF. During long-term follow-up (6 months after completion of treatment), the relapse rate was evaluated in both groups. RESULTS: At admission, all women had clinical and laboratory signs of cystitis. By the 14th day, there was normalization of evaluated parameters in both groups. However, in patients receiving systemic enzyme therapy a more rapid relief of the inflammatory process (a decrease in the frequency of urination, urgency, nocturia, severity of inflammatory changes in the blood and urine) by the 7th day of treatment was observed. During a further 6-month follow-up, relapses were detected in 9 (30%) and 4 (13.3%) patients in group 1 and 2, respectively. CONCLUSION: The results of the study demonstrated the high efficiency of systemic enzyme therapy. Its use for complex treatment provides more rapid relief of lower urinary tract symptoms and pain, as well as reduces the number of relapses in women with chronic recurrent bacterial cystitis.
https://doi.org/10.18565/urology.2020.2.35-40Experimental and Сlinical Urology · 2024 · 0 citations · open access
The search for alternative therapy for chronic cystitis: results of a prospective comparative randomized study on the effectiveness of a biologically active complex «Cystalis® D Plus».
AbstractIntroduction. Cystitis is one of the most prevalent urinary tract infection (UTI) type. An important specifity of cystitis is the tendency to relapse and chronization of the disease. The search for a safe and effective strategy for the treatment and prevention of recurrence of chronic cystitis is an extremely urgent problem. The purpose of this study is to compare the effectiveness of Cystalis® D Plus with antibiotics treatment in chronic cystitis relapses treatment. Materials and methods. The study included 120 patients with an established diagnosis of chronic cystitis at the moment of intensification. All patients were randomized into 4 groups: the first group received Cystalis® D Plus in monotherapy for 7 days, the second group received Cystalis® D Plus for 7 days together with nonsteroidal anti-inflammatory drugs (NSAIDs) in accordance with the recommendations, the third group received fosfomycin trometamol in accordance with the recommendations, the fourth group received fosfomycin trometamol together with NSAIDs in accordance with recommendations. All groups were monitored for a month after the start of therapy. Results. Patients from all groups noted a significant decrease in intensity of pain according to VAS already on the third day of treatment. Also, there was a significant decrease in the symptoms of acute cystitis on thescale «Acute cystitis symptom score» (ACSS scale), a decrease in the number of leukocytes in the urine and a decrease in microbial load in all groups. All the positive changes in the groups were comparable to each other. Conclusions. «Cystalis® D Plus» leads to rapid and persistent relief of symptoms of recurrent cystitis both in monotherapy mode and in combination with other groups of drugs.
https://doi.org/10.29188/2222-8543-2024-17-1-138-144Urogynaecologia · 2010 · 0 citations · open access
IDIOPATHIC RECURRENT CYSTITIS: A UROGYNAECOLOGICAL DILEMMA
AbstractDuring the first episode of cystitis, the general tendency is to proceed directly with treatment, postponing diagnosis, precisely because it is the first episode, and due to the impressiveness of the symptoms of acute cystitis, and also in the implicit hope that it may be an isolated episode that does not repeat itself. The usual recommendation is rest, abstention from sexual activity, and a mineral water cure. Wide spectrum antiseptic, anti-inflammatory, antispasmodic drugs and painkillers are prescribed. If, despite this, and perhaps after a short period of time, the episode relapses, a diagnosis should be performed. We are consequently dealing with Recurrent Cystitis.
https://doi.org/10.4081/uij.2004.29Disease module: DeepOracle (Open Targets). Structures: RDKit from PubChem SMILES. Literature: retrieved by DeepSearch across 234,678,978 indexed works (targeted per-candidate search), resolved on OpenAlex.
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