Emerging treatments
Your Organizational Guidance
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Cystitis bij de vrouwPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2017La cystite chez la femmePublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2017Vaccines
Uro-Vaxom® (also OM-89) has been studied in several randomized controlled trials and decreased the rate of urinary tract infection (UTI) recurrence.[62] Uro-Vaxom® is taken orally in capsule form and contains inactive extracts from 18 strains of Escherichia coli. This form of immunoprophylaxis has a well established safety profile and is licensed in many European countries. Uromune® (inactivated strains of E Coli, Klebsiella pneumoniae, Enterococcus faecalis, and Proteus vulgaris) is administered sublingually as a spray and is in clinical development for recurrent UTI prophylaxis. In one small, UK-based cohort study, a 3-month course of once-daily Uromune® was associated with the prevention of UTIs in the following 12 months, without any significant adverse effects.[63] An expanded access program for Uromune® in individuals who have not responded to antibiotic therapy is ongoing. Solco-Urovac® is a vaginal suppository that also contains E coli extracts and has been shown in small studies to increase time to recurrence of UTI in women with recurrent UTIs.[62][64] More robust evidence is required of its efficacy in larger cohorts of patients.
D-mannose
In a randomized controlled trial, D-mannose (a simple sugar) showed superiority in preventing UTIs in women with recurrent UTIs over placebo and was as effective as nitrofurantoin.[65] Other evidence suggests it is also helpful in the acute management of acute cystitis.[66] Authors of one Cochrane review evaluating D-mannose for UTIs in adults and children were unable to make any firm conclusions on its efficacy due to a significant lack of robust data.[67]
Intravesical instillation
Intravesical instillation to replace the glycosaminoglycan layer of the bladder is a standard treatment for interstitial cystitis. It has also been used to prevent recurrent UTIs. One review highlighted the need for more evidence for this indication.[68]
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