Bacteria, IC and self-treatment

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Bacteria, IC and self-treatment

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Editorial - Prevalence and impact of bacteriuria and/or urinary tract infection in interstitial cystitis/painful bladder syndrome

Written by Philip M. Hanno, MD
Wednesday, 18 August 2010


BERKELEY, CA (UroToday.com) - Is Self-Treatment With Antibiotics For Urinary Infection Symptoms Indicated for IC/BPS?

In an important article that breaks through the wealth of newly published material on IC/BPS, Dr. J. Curtis Nickel and colleagues from Kingston, Ontario and Cleveland, Ohio looked at a very common clinical problem and found incredibly interesting results that have the potential to affect routine urologic practice.

The clinical relevance of bacteriuria with uropathogenic bacteria in patients with IC/BPS is unknown. The authors evaluated the relationship between the culture status and IC/BPS-related symptoms in 100 female patients with intensive urine culture status documentation during 2 years of routine follow-up, treatment visits, and/or flare-related visits at a single-center IC clinic. Fifty-nine bacteriuria episodes occurred in 31 patients for a rate of bacteriuria for the entire cohort of 0.3 episodes per patient-year. E. coli accounted for 61% of the bacteriuria episodes and other gram-negative Enterobacteriaceae sp. and gram-positive organisms were cultured in 19% and 15% respectively. In 8 patients, bacteriuria was associated with intravesical therapy. All patients with positive cultures were treated with antibiotics.

No difference was seen in the patients identified with bacteriuria compared with those without bacteriuria in age, symptom duration, and symptom scores. During the 2-year study, no significant differences were seen in Interstitial Cystitis Symptom Index mean scores between the bacteriuria and sterile urine groups. No correlation was noted in the number of documented bacteriuria episodes and any of the numerous symptom indices evaluated. No significant difference was seen in any of the symptom indices evaluated among the baseline, during bacteriuria episodes, and after successful bacterial eradication. Nickel and colleagues conclude that the patients with bacteriuria did not differ from those without evidence of bacteriuria, the bacteriuria episodes did not appear to be associated with the symptom flares, and antibiotic treatment of documented bacteriuria was not associated with significant IC/BPS-related symptom amelioration.

The authors, as good scientists do, report the facts. But this paper leads me to speculate how it might impact upon my practice. Many IC/BPS patients like to keep antibiotics on hand. I will reconsider the practice, common in the female population with recurrent urinary infection from reinfection outside the urinary tract, of short-term self-treatment at the first sign of infection, with culture reserved only for non-responders. While this may make sense in the healthy cohort of women with recurrent UTI, based on Nickel’s data, self-initiated antibiotic therapy would seem to be a poor therapeutic option in the IC/BPS population. Both the symptoms of infection and the symptomatic relief associated with bacterial eradication may be masked by the disease.

Nickel JC, Shoskes DA, Irvine-Bird K

Urology. 2010 Jun 21. Epub ahead of print.
10.1016/j.urology.2010.03.065

PubMed Abstract
PMID: 20573386
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