Rationale for choosing an antibiotic for the treatment of cystitis: recommendations of clinical pharmacologists: A review

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Abstract

In recent years, the harmonization of domestic and foreign clinical recommendations for the treatment of cystitis has been achieved. Nitrofurans and fosfomycin trometamol are recommended as first line therapy antibiotics, and oral 3rd generation of cephalosporins are recommended as alternative antibiotics; fluoroquinolones are excluded from the recommended medications due to an unfavorable safety profile. The main rationale for inclusion of antibiotics in the recommendations as a first line therapy of cystitis is the level of resistance of uropathogens to antibiotics, primarily Escherichia coli. Stable low level of resistance of E. coli in Russia was noted to nitrofurans and fosfomycin (<5%), higher to cephalosporins. Among nitrofurans, furazidine is characterized by higher activity against E. coli compared to nitrofurantoin. The potassium salt of furazidine in dosage form with magnesium carbonate is preferred, since it is characterized by higher bioavailability and provides a therapeutic level of concentrations in urine above the MIC during the entire dosing period. Due to the global increase in the resistance of uropathogens observed in recent years, experts have begun to pay more and more attention to the ecological safety of antimicrobial therapy in order to minimize the risk of concomitant (collateral) damage, contributing to the selection of multi-drug resistant strains of microorganisms. In the latest WHO document of 2021, experts divided antibiotics into three groups (ACCESS, WATCH, RESERVE) according to the priority of choice. The ACCESS group of drugs for the treatment of cystitis includes nitrofurantoin and furazidine as agents with minimal collateral effect, while fosfomycin trometamol and cephalosporins are listed in the WATCH group. Thus, from the standpoint of ecological safety, WHO experts recommend prescribing nitrofurans in the treatment of cystitis in the first line of therapy.

About the authors

Sergey V. Yakovlev

Sechenov First Moscow State Medical University (Sechenov University); Yudin City Clinical Hospital

Author for correspondence.
Email: antimicrob@yandex.ru
ORCID iD: 0000-0001-7606-8608

д-р мед. наук, проф. каф. госпитальной терапии №2 Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет), врач – клинический фармаколог ГКБ им. С.С. Юдина

Russian Federation, Moscow; Moscow

Margarita P. Suvorova

Sechenov First Moscow State Medical University (Sechenov University); Yudin City Clinical Hospital

Email: antimicrob@yandex.ru
ORCID iD: 0000-0002-1389-6454

канд. мед. наук, доц. каф. госпитальной терапии №2 Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет), врач – клинический фармаколог ГКБ им. С.С. Юдина

Russian Federation, Moscow; Moscow

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2. Fig. 1. Antibiotic resistance of community-acquired strains of uropathogenic E. coli isolated from patients with uncomplicated and complicated urinary tract infections (UTIs) in Russia: DARMIS (2017–2018) [3] and RESOURCE (2017) studies [4].

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