Outcomes of Long-Term Antibiotic Therapy in Women with Chronic Recalcitrant Cystitis

Lower urinary tract symptoms (LUTS) may persist despite negative conventional urine cultures, potentially due to intracellular bacterial invasion, a condition described as chronic recalcitrant cystitis (CRC). Evidence evaluating CRC and the effectiveness of long-term antibiotic therapy for CRC remains limited. We aimed to evaluate patient-reported outcomes following long-term antibiotic treatment in women with CRC.

We conducted a retrospective review of women diagnosed with CRC who were treated with long-term antibiotics. Patient-reported outcome measures (PROMs) were assessed at baseline and at 1-year follow-up. Changes in PROMs were analyzed using paired t-tests or Wilcoxon signed-rank tests, as appropriate.

Thirty-five women were included; 25 (71.4%) were adherent to antibiotic therapy. At 1-year follow-up, adherent participants demonstrated significant improvement in Pelvic Floor Distress Inventory scores, particularly in the Urinary Distress Inventory subscale (p = 0.009, p < 0.001, respectively). Pain Catastrophizing Scale scores also improved (p = 0.02), although visual analog scale pain scores did not change significantly (p = 0.81). Among adherent participants, 73.9% reported complete resolution or improvement of LUTS. The mean time to symptom improvement was 6.0 ± 5.2 months. Long-term antibiotic therapy was generally well tolerated, with 27.3% reporting minor adverse effects, most commonly nausea and vulvovaginal candidiasis.

Long-term antibiotic therapy was associated with improvement in urinary symptoms, pelvic floor distress, and pain-related coping in women with CRC. Treatment was generally well tolerated. Prospective studies are needed to further define the role of long-term antibiotics in this population.