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HTML Rev.: Oct. 28, 1999
HTML Rev.: Oct. 28, 1999
You are here: IC Network > Patient Handbook > Treatments > Antibiotics
Antibiotic TherapyThe subject of antibiotic treatment for IC patients is both complex and controversial. Because our condition has series of flares and remissions, it's often very difficult to tell if you are having a flare or an actual bladder infection. Keep a voiding diary and/or pain log to track your daily progress for a few months. This should help you better understand your "normal" monthly flares.
In general, there are three different approaches to antibiotic use:
What follows is a small sampling of the various lines of thinking on antibiotics and IC, as well as the work of prominent researchers. More research is needed. The more that patients support fund-rasing efforts for research, the more these thought-provoking avenues of inquiry, and others, will be pursued. In all cases, consult your doctor and please read our disclaimer.
Doctors usually treat bladder infections in IC patients as they do bladder infections in other patients-- that is, they culture the urine and prescribe antibiotics.
IC patients typically get infections with the same organisms and use the same antibiotics as other patients. Cipro, Septra, Macrodantin and Keflex are some antibiotics that are commonly used to treat urinary tract infections. But because IC bladders are very sensitive, many patients have intense pain before there are enough bacteria to grow to significant levels in lab tests.
It is frustrating and often painful to have to wait to see the doctor, to repeat cultures, or to get antibiotics. Often times, your doctor may provide an antibiotic prior to the culture results. However, some of the very early theories of the cause of IC blamed the overuse of antibiotics. Whether that is true remains to be established, however we do know that the casual use of antibiotics can lead to the development of resistant strains of bacteria.
Try to wait until you have firm culture results before using antibiotics.. particularly antibiotic sensitivity results. Indiscriminate use of antibiotics can have long term effects and until you know what the bacteria is sensitive to, you can't really know if the antibiotic you are taking will be truly effective. Given the fact that most IC patients have been prescribed antibiotics in the past, it can be tempting to self-administer without getting culture results. Please reconsider this potentially dangerous practice.
If you have a fever, contact your doctor immediately, particularly if your fever spikes over 100 degrees. This may be a sign of an infection progressing to the kidneys. For pain relief, try using self help techniques like soaking in a tub, using a heat or cold pack, etc. You can also use oral medications such as PYRIDIUM & URISTAT.
Typically, doctors take a sample of fluid from a patient and perform a "culture" in order to determine if the patient's symptoms arise from a bacterial infection. That is, they supply the necessary nutrients, provide the proper conditions, and wait to see if bacteria grow from the sample. Many years ago urine was cultured in a "broth". But in recent years, in a step to save time and money, glass plates coated with agar have become the standard medium for urine cultures. What is more, the agar plate cultures are only allowed to "grow out" for 24 to 48 hours before a pathologist looks for signs of bacterial growth, and if bacterial growth is less than a certain level, the patient is deemed not to have an infection.
Dr. Fugazzotto performs a version of the "broth culture" technique on urine samples. He also allows the bacteria to grow for a longer time, and specifically looks for gram-positive organisms. According to Dr. Fugazzotto, most clean-catch urine samples sent to him by IC patients do grow out bacteria-- which he tests for sensitivity to various antibiotics. Although many IC patients have had their urine tested by Dr. Fugazzotto and have been treated with long-term antibiotics, not all are successful in improving their IC symptoms. The response to treatment is extremely variable-- some have no improvement at all while others experience almost total remission. Furthermore, the results may be temporary, or require lifelong maintenance doses of antibiotics to maintain the patient's comfort.
The ICA (Interstitial Cystitis Assn.) funded a pilot study to evaluate the antibiotic treatment recommended by Dr. Fugazzotto. Published in the Spring 1992 edition of the "ICA Update", the results indicated that 79% of IC patients experienced at least some symptomatic improvement as a result of the antibiotic therapy. Although this was not a placebo-controlled double-blind study, and it utilized results from less than a hundred patients, the study did lend support to the view that bacteria are involved in IC.
Their findings were startling: 29% of IC patients had bacterial DNA, while none of the non-IC patients did. Further investigation found a bacteria in the IC bladders that was gram-negative and possibly a new, unknown species. They published their findings in 1995 and set out to see if antibiotics could eradicate IC symptoms. Based on the appearance of the bacteria, they speculated that it might attack nerve tissue. So they designed a treatment regimen using Cipro and Rifampin.
After several months trial with a small group of IC patients, the results of treatment were mixed. Some patients had complete remissions, others had partial improvement, and still others had no response at all. Although their work is continuing and complete results will be published later, interim results show at best a 50% success rate for improvement on their antibiotic therapy.
Researchers Ruben Gittes, MD and Robert Nakamura, MD, of the Scripps Clinic and Research Foundation recently published a research study on Female Urethral Syndrome: A Female Prostatis" in the May 1996 issue of WJM. Their studies have conclusively proven that women do indeed have a set glands, the paraurethral glands, which are homologues of the male prostate. In the abstract for their research project, they state "The most important aspect of recognizing this microscopic 'female prostate' as an anatomical feature is that it's infections may completely explain many cases of the urethral syndrome."
Is this new? Actually, these glands were first described in 1672 by Regeneri de Graaf. In the late 1940's and 1950's, researcher Huffman was the first to describe the paraurethral glands in detail. In post mortem tissue exams, he consistently found inflammation in and about this area... and went on the record to say that an infection of these glands "play and important role in nonspecific urethritis." Unfortunately, the research community at the time wasn't receptive to this line of research. It wasn't until the past decade Huffman's theories have been validated by the use of new staining procedures which have proven that the paraurethral glands are indeed homologous to the male prostate. As such, it is easy to surmise that, like the male prostate, these may become infected.
Where are they? The microscopic paraurethral glands are found alongside the outer two thirds of the urethra.
How is this diagnosed in women? These researchers choose not to diagnose by exclusion. Much like the rectal examination of the prostate in men, they rely on a careful assessment of the tenderness of the glands through the vaginal wall to discover the presence of inflammation and infection. It seems to be no coincidence that IC researchers have documented similar distal vaginal tenderness.
Treatment Options: Drs. Gittes and Nakamura based much of their treatment based upon the treatment of men with prostate infections, specifically the use of "tissue-penetrating" antiobiotics. They state that because of the "inaccessibility and presumed stagnation of the glands" the treatment may require long term treatment with antiobiotics to achieve a cure. Progress of the treatment is assessed again via a vaginal re-examination. They further state that, like prostatitis, relapses may occur.
What does this mean for IC patients? We don't have any official comments from the IC research community. In fact, this article was obtained via the Prostatis Foundation. However, many IC patients have expressed frustration with the multiple diagnoses they have received and have speculated about any relationship between a diagnosis of IC versus one of urethral syndrome. While some doctors have expressed opinions that the syndromes are unrelated, others believe that urethral syndrome may be a milder form of IC.
Of special interest is the use of antiobiotics to treat this condition. With much "pro and con" discussion on the internet about the research of Dr. Durier, Domingue and Paul Fugazzotto, Ph.D., this study seems to support their research premise that IC may be bacterial in origin. The downside, of course, is that the use of repeated antiobiotics DOES promote the development of resistant bacterial strains and dramatic side effects in some patients. Because of this, patients should never self administer random antiobiotics without their physicians approval.