[Is there an alternative to antibiotics in patients with cystitis?]

Approaches to the treatment of cystitis have changed in recent years. Although the benefit of antibiotics in urinary tract infection is evident, excessive and inappropriate use has contributed to increased antimicrobial resistance among uropathogens and a higher rate of adverse events. Compared with placebo, clinical success of antibiotic therapy for cystitis is higher; however, in some cases the use of nutraceuticals, nonsteroidal anti-inflammatory drugs, and phytotherapy has made it possible to substantially reduce the frequency of antibiotic prescriptions.

To evaluate the efficiency, safety, and tolerability of Superlymph rectal/vaginal suppositories in patients with chronic cystitis during exacerbation as monotherapy.

This pilot open-label prospective non-comparative study included 30 female patients aged 20 to 49 years with chronic cystitis during exacerbation. All patients presented for the first time with frequency and painful urination (30/100%), dysuria with burning/pain on urination (22/73,3%), and blood drops from the urethra at the end of urination (7/23%). Disease duration did not exceed one day (mean 18,8+/-2,4 hours). Before seeking medical care, none of the patients had taken any medications. All patients refused antibiotics for different reasons: planned pregnancy in the near future; allergy or intolerance to antibacterial drugs; rapid development of bacterial vaginosis/vulvovaginal candidiasis or intestinal dysbiosis associated with prior antibacterial therapy. This refusal was confirmed by an official written refusal of antibacterial drugs within the study. All patients started therapy with a cytokine and antimicrobial peptide complex (Superlymph) as suppositories, administered rectally according to a two-stage regimen: during the intensive treatment phase lasting 20 days, Superlymph was prescribed at a dose of 25 IU daily; during the continuation phase, patients received 10 IU for 10 days.

At baseline, the mean total score on the ACSS scale was 14,9+/-2,3, and all patients had leukocyturia. Urine culture revealed bacterial growth in 24 patients (80,0%). By the end of the intensive phase, the mean total score decreased to 6,2+/-0,9. By the end of the continuation phase, all patients felt well; dysuria was completely resolved, which accordingly improved quality of life. The mean total score at the end of treatment was 1,9+/-0,2. No cystitis recurrences occurred within three months; during six months, recurrence was recorded in 4 patients (13,3%).

Superlymph monotherapy for chronic cystitis is highly effective and safe. Additional antibacterial therapy was required in only 13,3% of cases, while in 86,7% recurrence of chronic cystitis was controlled with Superlymph monotherapy. Three months after completion of therapy, none of the patients developed cystitis recurrence; within 6 months after completion of local cytokine therapy, recurrence occurred only in 4 patients (13,3%). No complications or adverse reactions during Superlymph therapy were observed.