The problem of recurrent cystitis from the perspective of a gynecologist. Possible ways to overcome

Objective. The review article is devoted to the problem of chronic recurrent lower urinary tract infections.

Results. An analysis of risk factors for the development of recurrent cystitis was carried out, including the role of disorders of the vaginal microbiome. It has been shown that the causative agent of bacterial vaginosis, Gardnerella vaginalis, when it enters the urinary tract, can act as a trigger during exacerbation of chronic cystitis in women. Anatomical and physiological features of the structure of the female urinary and reproductive systems, the presence of risk factors for possible reinfection, as well as the continuous increase in antibiotic resistance in microorganisms causes difficulties in determining the treatment algorithm and requires an integrated and differentiated approach to antibacterial drugs. Today, it is impossible to consider lower urinary tract infections in women in isolation and not take into account the state of the biocenosis of the vagina and intestines. A number of antibacterial drugs used for the treatment of cystitis can have a negative effect on the quantitative composition of lactobacilli, closing the vicious circle of recurrence of the disease. Among the drugs regulated by clinical protocols for the treatment of cystitis, nitrofurans, in particular nifuratel, are of greatest interest. The original drug has shown high effectiveness in the empirical treatment of cystitis as early as on the third day of use, with better tolerability compared to nitrofurantoin. It is also interesting because it has a spectrum of activity not only against the main uropathogens, but also against the causative agents of vaginal infections including bacterial vaginosis. At the same time, nifuratel does not suppress the growth of normal flora, in particular Lactobacillus spp., which makes it possible to normalize the microflora of adjacent reservoirs of infection, vagina and intestines, thereby preventing relapses of cystitis. In some cases, with concomitant vulvovaginitis, it is possible to use combination treatment with the addition of vaginal forms of the drug for persistent eradication of the pathogen, without the need for a second stage of treatment aimed at restoring the microbiome of the genital tract.

Conclusion. The described treatment option will provide a personalized approach to each patient, which significantly improves the quality of medical care for patients with chronic recurrent lower urinary tract infections on an outpatient basis.

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