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'''Cystitis''' is defined as "inflammation of the urinary bladder, either from bacterial or non-bacterial causes. Cystitis is usually associated with painful urination (dysuria), increased frequency, urgency, and suprapubic pain."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Cystitis |title=Cystitis |accessdate=2007-11-13 |author=National Library of Medicine |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref>
In medicine, '''cystitis''' is a form of [[urinary tract infection]] characterized by "inflammation of the urinary bladder, either from bacterial or non-bacterial causes. Cystitis is usually associated with painful urination (dysuria), increased frequency, urgency, and suprapubic pain."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Cystitis |title=Cystitis |accessdate=2007-11-13 |author=National Library of Medicine |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref>
 
[[Staphylococcus aureus]] is an usual cause that is increasingly occurring.<ref name="pmid19233426">{{cite journal |author=Routh JC, Alt AL, Ashley RA, Kramer SA, Boyce TG |title=Increasing prevalence and associated risk factors for methicillin resistant Staphylococcus aureus bacteriuria |journal=J. Urol. |volume=181 |issue=4 |pages=1694–8 |year=2009 |month=April |pmid=19233426 |doi=10.1016/j.juro.2008.11.108 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5347(08)03271-0 |issn=}}</ref> Staphylococcus aureus may be associated with the use of [[urinary catheterization]].<ref name="pmid19144410">{{cite journal |author=Saidel-Odes L, Riesenberg K, Schlaeffer F, Borer A |title=Epidemiological and clinical characteristics of methicillin sensitive Staphylococcus aureus (MSSA) bacteriuria |journal=J. Infect. |volume=58 |issue=2 |pages=119–22 |year=2009 |month=February |pmid=19144410 |doi=10.1016/j.jinf.2008.11.014 |url=http://linkinghub.elsevier.com/retrieve/pii/S0163-4453(08)00404-0 |issn=}}</ref>


==Diagnosis==
==Diagnosis==
Line 6: Line 8:


==Treatment==
==Treatment==
For uncomplicated cystitis, [[nitrofurantion]] 100 mg by mouth twice a day for 5 days may be used.<ref name="pmid17998493">{{cite journal |author=Gupta K, Hooton TM, Roberts PL, Stamm WE |title=Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women |journal=Arch. Intern. Med. |volume=167 |issue=20 |pages=2207–12 |year=2007 |pmid=17998493 |doi=10.1001/archinte.167.20.2207}}</ref>
Consider treatment if:<ref name="pmid19364448">{{cite journal |author=Little P, Turner S, Rumsby K, ''et al'' |title=Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study |journal=Health Technol Assess |volume=13 |issue=19 |pages=iii–iv, ix–xi, 1–73 |year=2009 |month=March |pmid=19364448 |doi=10.3310/hta13190 |url=http://www.hta.ac.uk/execsumm/summ1319.htm |issn=}}</ref>
* "48-hour delayed [[antibiotic]] prescription to be used at the patient`s discretion"
* or
* "target [[antibiotic]] treatment by dipsticks (positive nitrite or positive leucocytes and blood) with the offer of a delayed prescription if dipstick results are negative"
 
For uncomplicated cystitis, [[nitrofurantoin]] 100 mg by mouth twice a day for 5 days may be used.<ref name="pmid17998493">{{cite journal |author=Gupta K, Hooton TM, Roberts PL, Stamm WE |title=Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women |journal=Arch. Intern. Med. |volume=167 |issue=20 |pages=2207–12 |year=2007 |pmid=17998493 |doi=10.1001/archinte.167.20.2207}}</ref>


==Prevention==
==Prevention==
{| class="wikitable" align="right"
|+ Systematic reviews by the [[Cochrane Collaboration]] regarding the prevention of urinary tract infection
! Intervention!!Number of [[randomized controlled trial|trial]]s||[[Relative risk ratio]]
|-
| [[Antibiotic]]s<ref name="pmid15266443">{{cite journal |author=Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C |title=Antibiotics for preventing recurrent urinary tract infection in non-pregnant women |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD001209 |year=2004 |pmid=15266443 |doi=10.1002/14651858.CD001209.pub2 |url=http://dx.doi.org/10.1002/14651858.CD001209.pub2 |issn=}}</ref><br/>(Continuous or postcoital)||align="center"|10||align="center"|0.21
|-
| Intravaginal [[estrogen]]<ref name="pmid18425910">{{cite journal |author=Perrotta C, Aznar M, Mejia R, Albert X, Ng CW |title=Oestrogens for preventing recurrent urinary tract infection in postmenopausal women |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD005131 |year=2008 |pmid=18425910 |doi=10.1002/14651858.CD005131.pub2 |url=http://dx.doi.org/10.1002/14651858.CD005131.pub2 |issn=}}</ref>||align="center"|2||align="center"|0.25 to 0.64
|-
| [[Cranberry]]<ref name="pmid18253990">{{cite journal |author=Jepson RG, Craig JC |title=Cranberries for preventing urinary tract infections |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD001321 |year=2008 |pmid=18253990 |doi=10.1002/14651858.CD001321.pub4 |url=http://dx.doi.org/10.1002/14651858.CD001321.pub4 |issn=}}</ref>|| align="center"|10|| align="center"|0.65
|}
The following are measures that studies suggest may reduce the [[incidence]] of urinary tract infections. These may be appropriate for people, especially women, with recurrent infections:
The following are measures that studies suggest may reduce the [[incidence]] of urinary tract infections. These may be appropriate for people, especially women, with recurrent infections:
* Cleaning the urethral [[meatus]] (the opening of the [[urethra]]) after [[sexual intercourse|intercourse]] has been shown to be of some benefit; however, whether this is done with an [[antiseptic]] or a [[placebo]] ointment (an ointment containing no active ingredient) does not appear to matter.<ref name=meyhoff>{{cite journal | author = Meyhoff H, Nordling J, Gammelgaard P, Vejlsgaard R | title = Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis? | journal = Scand J Urol Nephrol | volume = 15 | issue = 2 | pages = 81-3 | year = 1981 | id = PMID 7036332}}</ref>
* Cleaning the urethral [[meatus]] (the opening of the [[urethra]]) after [[sexual intercourse|intercourse]] has been shown to be of some benefit; however, whether this is done with an [[antiseptic]] or a [[placebo]] ointment (an ointment containing no active ingredient) does not appear to matter.<ref name=meyhoff>{{cite journal | author = Meyhoff H, Nordling J, Gammelgaard P, Vejlsgaard R | title = Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis? | journal = Scand J Urol Nephrol | volume = 15 | issue = 2 | pages = 81-3 | year = 1981 | id = PMID 7036332}}</ref>
* [[Cranberry]] juice may decrease the incidence of cystitis according to a [[systematic review]] of [[randomized controlled trial]]s by the [[Cochrane Collaboration]]. The Cochrane concluded 'some evidence from trials to show cranberries (juice and capsules) can prevent recurrent infections in women. Many people in the trials stopped drinking the juice, suggesting it may not be a popular intervention'.<ref name=jepson>{{cite journal | author = Jepson R, Mihaljevic L, Craig J | title = Cranberries for preventing urinary tract infections. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD001321 | year = | id = PMID 14973968}}</ref>
* [[Cranberry]] juice may decrease the incidence of cystitis according to a [[systematic review]] of [[randomized controlled trial]]s by the [[Cochrane Collaboration]]. The [[relative risk]] of recurrence was 0.65 and the Cochrane concluded that cranberry 'juice may decrease the number of symptomatic UTIs ...large number of dropouts/withdrawals indicates that cranberry juice may not be acceptable over long periods of time'.<ref name="pmid18253990">{{cite journal |author=Jepson RG, Craig JC |title=Cranberries for preventing urinary tract infections |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD001321 |year=2008 |pmid=18253990 |doi=10.1002/14651858.CD001321.pub4 |url=http://dx.doi.org/10.1002/14651858.CD001321.pub4 |issn=}}</ref>
* For post-menopausal women, a [[randomized controlled trial]] has shown that intravaginal application of topical estrogen cream can prevent recurrent cystitis.<ref name=Raz>{{cite journal | author = Raz R, Stamm W | title = A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. | journal = N Engl J Med | volume = 329 | issue = 11 | pages = 753-6 | year = 1993 | id = PMID 8350884}}</ref> In this study, patients in the experimental group applied 0.5 mg of estriol vaginal cream nightly for two weeks followed by twice-weekly applications for eight months.
* Continuous antibiotic prophylaxis may decrease the incidence of cystitis according to a [[systematic review]] of [[randomized controlled trial]]s by the [[Cochrane Collaboration]].<ref name="pmid15266443">{{cite journal |author=Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C |title=Antibiotics for preventing recurrent urinary tract infection in non-pregnant women |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD001209 |year=2004 |pmid=15266443 |doi=10.1002/14651858.CD001209.pub2 |url=http://dx.doi.org/10.1002/14651858.CD001209.pub2 |issn=}}</ref> The [[relative risk]] of recurrence was 0.21. Nitrofurantoin may<ref name="pmid4044461">{{cite journal |author=Brumfitt W, Smith GW, Hamilton-Miller JM, Gargan RA |title=A clinical comparison between Macrodantin and trimethoprim for prophylaxis in women with recurrent urinary infections |journal=J. Antimicrob. Chemother. |volume=16 |issue=1 |pages=111–20 |year=1985 |month=July |pmid=4044461 |doi= |url=http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=4044461 |issn=}}</ref> or may not<ref name="pmid6992677">{{cite journal |author=Stamm WE, Counts GW, Wagner KF, ''et al'' |title=Antimicrobial prophylaxis of recurrent urinary tract infections: a double-blind, placebo-controlled trial |journal=Ann. Intern. Med. |volume=92 |issue=6 |pages=770–5 |year=1980 |month=June |pmid=6992677 |doi= |url= |issn=}}</ref> be more effective than trimethoprim monotherapy.
* Postcoital antibiotics may be effective [[randomized controlled trial]].<ref name="pmid2197450">{{cite journal |author=Stapleton A, Latham RH, Johnson C, Stamm WE |title=Postcoital antimicrobial prophylaxis for recurrent urinary tract infection. A randomized, double-blind, placebo-controlled trial |journal=JAMA |volume=264 |issue=6 |pages=703–6 |year=1990 |month=August |pmid=2197450 |doi= |url= |issn=}}</ref><ref name="pmid15266443">{{cite journal |author=Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C |title=Antibiotics for preventing recurrent urinary tract infection in non-pregnant women |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD001209 |year=2004 |pmid=15266443 |doi=10.1002/14651858.CD001209.pub2 |url=http://dx.doi.org/10.1002/14651858.CD001209.pub2 |issn=}}</ref>
 
{| class="wikitable" align="right"
|+ Selected randomized controlled trials of intravaginal estrogen for the prevention of urinary tract infection
! Author, year!!Duration of study!! change in pH in treatment group!!colspan="2"|Rates of recurrence||[[Relative risk ratio]]
|-
| Raz, 1993<ref name="pmid8350884">{{cite journal | author = Raz R, Stamm W | title = A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. | journal = N Engl J Med | volume = 329 | issue = 11 | pages = 753-6 | year = 1993 | id = PMID 8350884|url=http://content.nejm.org/cgi/content/full/329/11/753|doi=10.1056/NEJM199309093291102}}</ref>||align="center"|8 months||align="center"|5.5 to 3.6||Intravaginal [[estrogen]] cream:<br/><center>16%</center>||Placebo:<br/><center>63%</center>||align="center"|0.25
|-
| Eriksen, 1999<ref name="pmid10329858">{{cite journal |author=Eriksen B |title=A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women |journal=Am. J. Obstet. Gynecol. |volume=180 |issue=5 |pages=1072–9 |year=1999 |month=May |pmid=10329858 |doi= |url= |issn=}}</ref>||align="center"|9 months||align="center"|6.7 to 5.3||Intravaginal [[estrogen]] via vaginal ring:<br/><center>55%</center>||No treatment:<br/><center>80%</center>||align="center"|0.64
|-
| Raz, 2003<ref name="pmid12766829">{{cite journal |author=Raz R, Colodner R, Rohana Y, ''et al'' |title=Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women |journal=Clin. Infect. Dis. |volume=36 |issue=11 |pages=1362–8 |year=2003 |month=June |pmid=12766829 |doi=10.1086/374341 |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID30441 |issn=}}</ref>|| align="center"|9 months||align="center"|5.6 to 5.3||Intravaginal [[estrogen]] via pessary:<br/><center>67%</center>||[[Nitrofurantoin]]:<br/><center>52%</center>||&nbsp;
|}
* For post-menopausal women, a [[randomized controlled trial]]<ref name="pmid8350884">{{cite journal | author = Raz R, Stamm W | title = A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. | journal = N Engl J Med | volume = 329 | issue = 11 | pages = 753-6 | year = 1993 | id = PMID 8350884|url=http://content.nejm.org/cgi/content/full/329/11/753|doi=10.1056/NEJM199309093291102}}</ref> and a meta-analysis<ref name="pmid18425910">{{cite journal |author=Perrotta C, Aznar M, Mejia R, Albert X, Ng CW |title=Oestrogens for preventing recurrent urinary tract infection in postmenopausal women |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD005131 |year=2008 |pmid=18425910 |doi=10.1002/14651858.CD005131.pub2 |url=http://dx.doi.org/10.1002/14651858.CD005131.pub2 |issn=}}</ref> by the [[Cochrane Collaboration]] has shown that intravaginal  [[estrogen]] cream can prevent recurrent cystitis. The [[relative risk]] of recurrence was 0.25<ref name="pmid8350884"/> to 0.64<ref name="pmid10329858"/> in the two trials included in the review. In the original trial in 1993, patients in the experimental group applied 0.5 mg of estriol vaginal cream nightly for two weeks followed by twice-weekly applications for eight months<ref name="pmid8350884"/>.
** Higher dose of intravaginal estrogen cream (1 mg estriol daily for two weeks then twice a week for two additional weeks) may help premenopausal women for 11 months.<ref name="pmid15661421">{{cite journal |author=Pinggera GM, Feuchtner G, Frauscher F, ''et al'' |title=Effects of local estrogen therapy on recurrent urinary tract infections in young females under oral contraceptives |journal=Eur. Urol. |volume=47 |issue=2 |pages=243–9 |year=2005 |month=February |pmid=15661421 |doi=10.1016/j.eururo.2004.09.008 |url=http://linkinghub.elsevier.com/retrieve/pii/S0302-2838(04)00482-8 |issn=}}</ref> However, this study was uncontrolled.
** Intravaginal estrogen via estriol pessary may not be effective.<ref name="pmid12766829">{{cite journal |author=Raz R, Colodner R, Rohana Y, ''et al'' |title=Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women |journal=Clin. Infect. Dis. |volume=36 |issue=11 |pages=1362–8 |year=2003 |month=June |pmid=12766829 |doi=10.1086/374341 |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID30441 |issn=}}</ref>
** Intravaginal estrogen may be more effective than continuous oral antibiotics<ref name="pmid11769665">{{cite journal |author=Xu R, Wu Y, Hu Y |title=[Prevention and treatment of recurrent urinary system infection with estrogen cream in postmenopausal women] |language=Chinese |journal=Zhonghua Fu Chan Ke Za Zhi |volume=36 |issue=9 |pages=531–3 |year=2001 |month=September |pmid=11769665 |doi= |url= |issn=}}</ref>. However, this is not true of the estrogen pessary due to inability to restore normal [[lactobacillus|lactobacilli]] and lower vaginal pH.<ref name="pmid12766829"/>


==References==
==References==
<references/>
<references/>

Latest revision as of 12:23, 7 May 2009

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In medicine, cystitis is a form of urinary tract infection characterized by "inflammation of the urinary bladder, either from bacterial or non-bacterial causes. Cystitis is usually associated with painful urination (dysuria), increased frequency, urgency, and suprapubic pain."[1]

Staphylococcus aureus is an usual cause that is increasingly occurring.[2] Staphylococcus aureus may be associated with the use of urinary catheterization.[3]

Diagnosis

A clinical prediction rule suggests that if a patient has at least two of 1) dysuria, 2) the presence of more than trace leukocytes, 3) or the presence of nitrites, the diagnosis is sufficiently likely to consider empirical treatment.[4]

Treatment

Consider treatment if:[5]

  • "48-hour delayed antibiotic prescription to be used at the patient`s discretion"
  • or
  • "target antibiotic treatment by dipsticks (positive nitrite or positive leucocytes and blood) with the offer of a delayed prescription if dipstick results are negative"

For uncomplicated cystitis, nitrofurantoin 100 mg by mouth twice a day for 5 days may be used.[6]

Prevention

Systematic reviews by the Cochrane Collaboration regarding the prevention of urinary tract infection
Intervention Number of trials Relative risk ratio
Antibiotics[7]
(Continuous or postcoital)		 10 0.21
Intravaginal estrogen[8] 2 0.25 to 0.64
Cranberry[9] 10 0.65

The following are measures that studies suggest may reduce the incidence of urinary tract infections. These may be appropriate for people, especially women, with recurrent infections:

Selected randomized controlled trials of intravaginal estrogen for the prevention of urinary tract infection
Author, year Duration of study change in pH in treatment group Rates of recurrence Relative risk ratio
Raz, 1993[14] 8 months 5.5 to 3.6 Intravaginal estrogen cream:
16%
 Placebo:
63%
 0.25
Eriksen, 1999[15] 9 months 6.7 to 5.3 Intravaginal estrogen via vaginal ring:
55%
 No treatment:
80%
 0.64
Raz, 2003[16] 9 months 5.6 to 5.3 Intravaginal estrogen via pessary:
67%
 Nitrofurantoin:
52%
  
  • For post-menopausal women, a randomized controlled trial[14] and a meta-analysis[8] by the Cochrane Collaboration has shown that intravaginal estrogen cream can prevent recurrent cystitis. The relative risk of recurrence was 0.25[14] to 0.64[15] in the two trials included in the review. In the original trial in 1993, patients in the experimental group applied 0.5 mg of estriol vaginal cream nightly for two weeks followed by twice-weekly applications for eight months[14].
    • Higher dose of intravaginal estrogen cream (1 mg estriol daily for two weeks then twice a week for two additional weeks) may help premenopausal women for 11 months.[17] However, this study was uncontrolled.
    • Intravaginal estrogen via estriol pessary may not be effective.[16]
    • Intravaginal estrogen may be more effective than continuous oral antibiotics[18]. However, this is not true of the estrogen pessary due to inability to restore normal lactobacilli and lower vaginal pH.[16]

References

  1. ↑ National Library of Medicine. Cystitis. Retrieved on 2007-11-13.
  2. ↑ Routh JC, Alt AL, Ashley RA, Kramer SA, Boyce TG (April 2009). "Increasing prevalence and associated risk factors for methicillin resistant Staphylococcus aureus bacteriuria". J. Urol. 181 (4): 1694–8. DOI:10.1016/j.juro.2008.11.108. PMID 19233426. Research Blogging.
  3. ↑ Saidel-Odes L, Riesenberg K, Schlaeffer F, Borer A (February 2009). "Epidemiological and clinical characteristics of methicillin sensitive Staphylococcus aureus (MSSA) bacteriuria". J. Infect. 58 (2): 119–22. DOI:10.1016/j.jinf.2008.11.014. PMID 19144410. Research Blogging.
  4. ↑ McIsaac WJ, Moineddin R, Ross S (2007). "Validation of a decision aid to assist physicians in reducing unnecessary antibiotic drug use for acute cystitis". Arch. Intern. Med. 167 (20): 2201–6. DOI:10.1001/archinte.167.20.2201. PMID 17998492. Research Blogging.
  5. ↑ Little P, Turner S, Rumsby K, et al (March 2009). "Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study". Health Technol Assess 13 (19): iii–iv, ix–xi, 1–73. DOI:10.3310/hta13190. PMID 19364448. Research Blogging.
  6. ↑ Gupta K, Hooton TM, Roberts PL, Stamm WE (2007). "Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women". Arch. Intern. Med. 167 (20): 2207–12. DOI:10.1001/archinte.167.20.2207. PMID 17998493. Research Blogging.
  7. ↑ 7.0 7.1 7.2 Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C (2004). "Antibiotics for preventing recurrent urinary tract infection in non-pregnant women". Cochrane Database Syst Rev (3): CD001209. DOI:10.1002/14651858.CD001209.pub2. PMID 15266443. Research Blogging.
  8. ↑ 8.0 8.1 Perrotta C, Aznar M, Mejia R, Albert X, Ng CW (2008). "Oestrogens for preventing recurrent urinary tract infection in postmenopausal women". Cochrane Database Syst Rev (2): CD005131. DOI:10.1002/14651858.CD005131.pub2. PMID 18425910. Research Blogging.
  9. ↑ 9.0 9.1 Jepson RG, Craig JC (2008). "Cranberries for preventing urinary tract infections". Cochrane Database Syst Rev (1): CD001321. DOI:10.1002/14651858.CD001321.pub4. PMID 18253990. Research Blogging.
  10. ↑ Meyhoff H, Nordling J, Gammelgaard P, Vejlsgaard R (1981). "Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis?". Scand J Urol Nephrol 15 (2): 81-3. PMID 7036332.
  11. ↑ Brumfitt W, Smith GW, Hamilton-Miller JM, Gargan RA (July 1985). "A clinical comparison between Macrodantin and trimethoprim for prophylaxis in women with recurrent urinary infections". J. Antimicrob. Chemother. 16 (1): 111–20. PMID 4044461. [e]
  12. ↑ Stamm WE, Counts GW, Wagner KF, et al (June 1980). "Antimicrobial prophylaxis of recurrent urinary tract infections: a double-blind, placebo-controlled trial". Ann. Intern. Med. 92 (6): 770–5. PMID 6992677. [e]
  13. ↑ Stapleton A, Latham RH, Johnson C, Stamm WE (August 1990). "Postcoital antimicrobial prophylaxis for recurrent urinary tract infection. A randomized, double-blind, placebo-controlled trial". JAMA 264 (6): 703–6. PMID 2197450. [e]
  14. ↑ 14.0 14.1 14.2 14.3 Raz R, Stamm W (1993). "A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections.". N Engl J Med 329 (11): 753-6. DOI:10.1056/NEJM199309093291102. PMID 8350884. Research Blogging.
  15. ↑ 15.0 15.1 Eriksen B (May 1999). "A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women". Am. J. Obstet. Gynecol. 180 (5): 1072–9. PMID 10329858. [e]
  16. ↑ 16.0 16.1 16.2 Raz R, Colodner R, Rohana Y, et al (June 2003). "Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women". Clin. Infect. Dis. 36 (11): 1362–8. DOI:10.1086/374341. PMID 12766829. Research Blogging.
  17. ↑ Pinggera GM, Feuchtner G, Frauscher F, et al (February 2005). "Effects of local estrogen therapy on recurrent urinary tract infections in young females under oral contraceptives". Eur. Urol. 47 (2): 243–9. DOI:10.1016/j.eururo.2004.09.008. PMID 15661421. Research Blogging.
  18. ↑ Xu R, Wu Y, Hu Y (September 2001). "[Prevention and treatment of recurrent urinary system infection with estrogen cream in postmenopausal women]" (in Chinese). Zhonghua Fu Chan Ke Za Zhi 36 (9): 531–3. PMID 11769665. [e]
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