Tablets for the treatment of the genitourinary system in women. Treatment of urinary tract infections: medicinal and alternative

Urinary tract infection (UTI) is the growth of microorganisms in various parts of the kidneys and urinary tract (UT), which can cause an inflammatory process, localized corresponding to the disease (pyelonephritis, cystitis, urethritis, etc.).

UTI in children occurs in Russia with a frequency of about 1000 cases per 100,000 population. Quite often, UTIs tend to be chronic and recurrent. This is explained by the peculiarities of the structure, blood circulation, innervation of the MP and age-related dysfunction of the immune system of the growing child’s body. In this regard, it is customary to identify a number of factors contributing to the development of UTI:

• disturbance of urodynamics;
• neurogenic bladder dysfunction;
• severity of pathogenic properties of microorganisms (adhesion, release of urease);
• features of the patient’s immune response (decreased cell-mediated immunity, insufficient production of antibodies to the pathogen, production of autoantibodies);
• functional and organic disorders of the distal parts of the colon (constipation, imbalance of intestinal microflora).

In childhood, UTIs in 80% of cases develop against the background of congenital anomalies of the upper and lower bladders, in which there are urodynamic disturbances. In such cases, they speak of complicated UTI. In an uncomplicated form, anatomical disorders and urodynamic disorders are not determined.

Among the most common malformations of the urinary tract, vesicoureteral reflux occurs in 30-40% of cases. Second place goes to megaureter, neurogenic bladder dysfunction. With hydronephrosis, kidney infection occurs less frequently.

Diagnosis of UTI is based on many principles. It must be remembered that the symptoms of a UTI depend on the age of the child. For example, newborns do not have specific symptoms of UTI and the infection is rarely generalized.

Symptoms such as lethargy, restlessness, periodic rises in temperature, anorexia, vomiting and jaundice are typical for young children.

Older children are characterized by fever, back pain, abdominal pain and dysuria.

The list of questions when collecting anamnesis includes the following items:

• heredity;
• complaints when urinating (frequency, pain);
• previous episodes of infection;
• unexplained rises in temperature;
• presence of thirst;
• amount of urine excreted;
• in detail: straining during urination, diameter and intermittency of the stream, imperative urges, rhythm of urination, daytime urinary incontinence, nocturnal enuresis, frequency of bowel movements.

The doctor should always strive to more accurately determine the location of a possible source of infection: the type of treatment and prognosis of the disease depend on this. To clarify the topic of urinary tract damage, it is necessary to have a good knowledge of the clinical symptoms of lower and upper urinary tract infections. In case of upper urinary tract infection, pyelonephritis is significant, which accounts for up to 60% of all cases of hospitalization of children in hospital ( ).

However, the basis for diagnosing UTIs is the data of urine tests, in which microbiological methods are of primary importance. Isolation of the microorganism in urine culture serves as the basis for diagnosis. There are several ways to collect urine:

• intake from the middle portion of the stream;
• urine collection into a urinal (in 10% of healthy children up to 50,000 CFU/ml, at 100,000 CFU/ml the analysis should be repeated);
• catheterization through the urethra;
• suprapubic aspiration (not used in Russia).

A common indirect method for assessing bacteriuria is a nitrite test (nitrates normally found in urine are converted to nitrites in the presence of bacteria). The diagnostic value of this method reaches 99%, but in young children, due to the short stay of urine in the bladder, it is significantly reduced and reaches 30-50%. It must be remembered that in young boys a false positive result may occur due to the accumulation of nitrites in the preputial sac.

Most cases of UTI are caused by one type of microorganism. The detection of several types of bacteria in samples is most often explained by violations of the technique for collecting and transporting the material.

In chronic UTIs, in some cases it is possible to identify microbial associations.

Other methods for examining urine include collecting a general urine test, the Nechiporenko and Addis-Kakovsky tests. Leukocyturia is observed in all cases of UTI, but it must be remembered that it can also occur, for example, with vulvitis. Gross hematuria occurs in 20-25% of children with cystitis. In the presence of symptoms of infection, proteinuria confirms the diagnosis of pyelonephritis.

Instrumental examinations are carried out for children during the period of remission of the process. Their purpose is to clarify the location of the infection, the cause and extent of kidney damage. Examination of children with UTIs today includes:

• ultrasound scanning;
• voiding cystography;
• cystoscopy;
• excretory urography (obstruction in girls - 2%, in boys - 10%);
• radioisotope renography;
• nephroscintigraphy with DMSA (scar forms within 1-2 years);
• urodynamic studies.

Instrumental and x-ray examinations should be performed according to the following indications:

• pyelonephritis;
• bacteriuria under 1 year of age;
• increased blood pressure;
• palpable mass in the abdomen;
• spinal abnormalities;
• decreased urine concentrating function;
• asymptomatic bacteriuria;
• relapses of cystitis in boys.

The bacterial etiology of UTI in urological diseases has distinctive features depending on the severity of the process, the frequency of complicated forms, the age of the patient and the state of his immune status, the conditions of the infection (outpatient or in hospital).

Research results (data from the Scientific Center for Children's Diseases of the Russian Academy of Medical Sciences, 2005) show that in outpatients with UTI in 50% of cases there are E. coli, at 10 o'clock% - Proteus spp., in 13% - Klebsiella spp., at 3% - Enterobacter spp., at 2% - Morganella morg. and with a frequency of 11% - Enterococcus fac. ( ). Other microorganisms, accounting for 7% of the isolation and occurring at a frequency of less than 1%, were as follows: S. epidermidis — 0,8%, S. pneumoniae — 0,6%, Acinetobacter spp. — 0,6%, Citrobacter spp. — 0,3%, S. pyogenes — 0,3%, Serratia spp. — 0,3%.

In the structure of nosocomial infections, UTIs occupy second place, after respiratory tract infections. It should be noted that 5% of children in a urological hospital develop infectious complications caused by surgical or diagnostic intervention.

In inpatients, the etiological significance of E. coli is significantly reduced (up to 29%) due to the increase and/or addition of such “problematic” pathogens as Pseudomonas aeruginosa (29%), Enterococcus faec.(4%), coagulase-negative staphylococci (2.6%), non-fermenting gram-negative bacteria ( Acinetobacter spp. — 1,6%, Stenotrophomonas maltophilia- 1.2%), etc. The sensitivity of these pathogens to antibacterial drugs is often unpredictable, as it depends on a number of factors, including the characteristics of nosocomial strains circulating in a given hospital.

There is no doubt that the main objectives in the treatment of patients with UTIs are the elimination or reduction of the inflammatory process in the renal tissue and bladder, and the success of treatment is largely determined by rational antimicrobial therapy.

Naturally, when choosing a drug, the urologist is guided primarily by information about the causative agent of the infection and the spectrum of the antimicrobial action of the drug. An antibiotic may be safe, capable of creating high concentrations in the kidney parenchyma and urine, but if its spectrum does not have activity against a specific pathogen, prescribing such a drug is pointless.

A global problem in prescribing antibacterial drugs is the increasing resistance of microorganisms to them. Moreover, resistance most often develops in community-acquired and nosocomial patients. Those microorganisms that are not included in the antibacterial spectrum of any antibiotic are naturally considered resistant. Acquired resistance means that a microorganism that was initially sensitive to a particular antibiotic becomes resistant to its action.

In practice, people are often mistaken about acquired resistance, believing that its occurrence is inevitable. But science has facts that refute this opinion. The clinical significance of these facts is that antibiotics that do not cause resistance can be used without fear of its subsequent development. But if the development of resistance is potentially possible, then it appears quite quickly. Another misconception is that the development of resistance is associated with the use of antibiotics in large quantities. Examples from the world's most commonly prescribed antibiotic, ceftriaxone, as well as cefoxitin and cefuroxime, support the concept that the use of antibiotics with low resistance potential at any level will not lead to further increases in resistance.

Many people believe that the emergence of antibiotic resistance is typical for some classes of antibiotics (this opinion applies to third-generation cephalosporins), but not for others. However, the development of resistance is not related to the class of antibiotic, but to the specific drug.

If an antibiotic has the potential to develop resistance, signs of resistance to it appear within the first 2 years of use or even during clinical trials. Based on this, we can confidently predict problems of resistance: among aminoglycosides - gentamicin, among second generation cephalosporins - cefamandole, third generation - ceftazidime, among fluoroquinolones - trovofloxacin, among carbapenems - imipenem. The introduction of imipenem into practice was accompanied by the rapid development of resistance to it in P. aeruginosa strains; this process continues today (the appearance of meropenem was not associated with such a problem, and it can be argued that it will not arise in the near future). Among the glycopeptides is vancomycin.

As already indicated, 5% of hospitalized patients develop infectious complications. Hence the severity of the condition, and the increase in recovery time, hospital stay, and increase in the cost of treatment. In the structure of nosocomial infections, UTIs occupy first place, followed by surgical ones (wound infections of the skin and soft tissues, abdominal infections).

The difficulties of treating hospital-acquired infections are determined by the severity of the patient’s condition. Often there is an association of pathogens (two or more, with a wound or catheter-associated infection). Also of great importance is the increased resistance of microorganisms in recent years to traditional antibacterial drugs (penicillins, cephalosporins, aminoglycosides) used for infections of the genitourinary system.

To date, the sensitivity of hospital strains of Enterobacter spp. to Amoxiclav (amoxicillin + clavulanic acid) is 40%, to cefuroxime - 30%, to gentamicin - 50%, the sensitivity of S. aureus to oxacillin is 67%, to lincomycin - 56%, to ciprofloxacin - 50%, to gentamicin - 50 %. The sensitivity of P. aeruginosa strains to ceftazidime in different departments does not exceed 80%, and to gentamicin - 50%.

There are two potential approaches to overcome antibiotic resistance. The first is to prevent resistance, for example by limiting the use of antibiotics that have a high potential for developing resistance; Equally important are effective epidemiological control programs to prevent the spread of hospital-acquired infections caused by highly resistant microorganisms in a health care setting (inpatient monitoring). The second approach is to eliminate or correct existing problems. For example, if resistant strains are common in the intensive care unit (or in the hospital in general) P. aeruginosa or Enterobacter spp., then a complete replacement in the formularies of antibiotics with a high potential for the development of resistance with “cleaner” antibiotics (amikacin instead of gentamicin, meropenem instead of imipenem, etc.) will eliminate or minimize antibiotic resistance of gram-negative aerobic microorganisms.

In the treatment of UTIs, the following are currently used: inhibitor-protected penicillins, cephalosporins, aminoglycosides, carbapenems, fluoroquinolones (limited in pediatrics), uroantiseptics (nitrofuran derivatives - Furagin).

Let us dwell on antibacterial drugs in the treatment of UTIs in more detail.

1. Inhibitor-protected aminopenicillins: amoxicillin + clavulanic acid (Amoxiclav, Augmentin, Flemoklav Solutab), ampicillin + sulbactam (Sulbacin, Unazin).
2. II generation cephalosporins: cefuroxime, cefaclor.
3. Fosfomycin.
4. Nitrofuran derivatives: furazolidone, furaltadone (Furazolin), nitrofural (Furacilin).

For upper urinary tract infection.

1. Inhibitor-protected aminopenicillins: amoxicillin + clavulanic acid, ampicillin + sulbactam.
2. II generation cephalosporins: cefuroxime, cefamandole.
3. III generation cephalosporins: cefotaxime, ceftazidime, ceftriaxone.
4. IV generation cephalosporins: cefepime.
5. Aminoglycosides: netilmicin, amikacin.

For hospital infection.

1. Cephalosporins of the III and IV generations - ceftazidime, cefoperazone, cefepime.
2. Ureidopenicillins: piperacillin.
3. Fluoroquinolones: according to indications.
4. Aminoglycosides: amikacin.
5. Carbapenems: imipenem, meropenem.

For perioperative antibacterial prophylaxis.

1. Inhibitor-protected aminopenicillins: amoxicillin + clavulanic acid, ticarcillin/clavulanate.
2. Cephalosporins of the II and III generations: cefuroxime, cefotaxime, ceftriaxone, ceftazidime, cefoperazone.

For antibacterial prophylaxis during invasive procedures: inhibitor-protected aminopenicillins - amoxicillin + clavulanic acid.

It is generally accepted that antibiotic therapy in outpatients with UTI can be performed empirically, based on the antibiotic susceptibility data of the main uropathogens circulating in a particular region during a given observation period and the clinical status of the patient.

The strategic principle of antibiotic therapy in outpatient settings is the principle of minimal sufficiency. First-line drugs are:

• inhibitor-protected aminopenicillins: amoxicillin + clavulanic acid (Amoxiclav);
• cephalosporins: oral cephalosporins of the II and III generations;
• derivatives of the nitrofuran series: nitrofurantoin (Furadonin), furazidin (Furagin).

It is erroneous to use ampicillin and co-trimoxazole in outpatient settings due to increased resistance to them E. coli. The use of first generation cephalosporins (cephalexin, cefradine, cefazolin) is not justified. Derivatives of the nitrofuran series (Furagin) do not create therapeutic concentrations in the renal parenchyma, so they are prescribed only for cystitis. In order to reduce the growth of resistance of microorganisms, the use of third-generation cephalosporins should be sharply limited and the use of aminoglycosides in outpatient practice should be completely eliminated.

Analysis of the resistance of strains of pathogens of complicated urinary infections shows that the activity of drugs from the group of semisynthetic penicillins and protected penicillins can be quite high against Escherichia coli and Proteus, but against enterobacteria and Pseudomonas aeruginosa their activity is up to 42 and 39%, respectively. Therefore, drugs in this group cannot be drugs for empirical treatment of severe purulent-inflammatory processes of the urinary organs.

The activity of cephalosporins of the first and second generations against Enterobacter and Proteus also turns out to be very low and ranges from 15-24%; against E. coli it is slightly higher, but does not exceed the activity of semisynthetic penicillins.

The activity of cephalosporins of the III and IV generations is significantly higher than that of penicillins and cephalosporins of the I and II generations. The highest activity was observed against E. coli - from 67 (cefoperazone) to 91% (cefepime). Activity against Enterobacter ranges from 51 (ceftriaxone) to 70% (cefepime); high activity of drugs in this group is also noted against Proteus (65-69%). The activity of this group of drugs against Pseudomonas aeruginosa is low (15% for ceftriaxone, 62% for cefepime). The spectrum of antibacterial activity of ceftazidime is the highest against all current gram-negative pathogens of complicated infections (from 80 to 99%). The activity of carbapenems remains high - from 84 to 100% (for imipenem).

The activity of aminoglycosides is somewhat lower, especially against enterococci, but amikacin retains high activity against enterobacteria and Proteus.

For this reason, antibacterial therapy for UTIs in urological patients in a hospital should be based on data from microbiological diagnostics of the infectious agent in each patient and his sensitivity to antibacterial drugs. Initial empirical antimicrobial therapy for urological patients can be prescribed only until the results of a bacteriological study are obtained, after which it should be changed according to the antibiotic sensitivity of the isolated microorganism.

When using antibiotic therapy in a hospital, a different principle should be followed - from simple to powerful (minimum use, maximum intensity). The range of groups of antibacterial drugs used here has been significantly expanded:

• inhibitor-protected aminopenicillins;
• cephalosporins of III and IV generations;
• aminoglycosides;
• carbapenems;
• fluoroquinolones (in severe cases and in the presence of microbiological confirmation of sensitivity to these drugs).

Perioperative antibiotic prophylaxis (pre-, intra- and post-operative) is important in the work of a pediatric urologist. Of course, one should not neglect the influence of other factors that reduce the likelihood of developing an infection (reducing hospital stay, quality of processing of instruments, catheters, use of closed systems for urine diversion, staff training).

Major studies show that postoperative complications are prevented if a high concentration of antibacterial drug in the blood serum (and tissues) is created before the start of surgery. In clinical practice, the optimal time for antibiotic prophylaxis is 30-60 minutes before the start of surgery (subject to intravenous administration of the antibiotic), i.e. at the beginning of anesthesia. There was a significant increase in the incidence of postoperative infections if the prophylactic dose of antibiotic was not prescribed within 1 hour before surgery. Any antibacterial drug administered after closing the surgical wound will not affect the likelihood of complications.

Thus, a single administration of an adequate antibacterial drug for prophylactic purposes is no less effective than repeated administration. Only with long-term surgery (more than 3 hours) an additional dose is required. Antibiotic prophylaxis cannot last more than 24 hours, since in this case the use of an antibiotic is considered as therapy, and not as prevention.

An ideal antibiotic, including for perioperative prophylaxis, should be highly effective, well tolerated by patients, and have low toxicity. Its antibacterial spectrum should include probable microflora. For patients staying in hospital for a long time before surgery, it is necessary to take into account the spectrum of nosocomial microorganisms, taking into account their antibiotic sensitivity.

For antibiotic prophylaxis during urological operations, it is advisable to use drugs that create high concentrations in the urine. Many antibiotics meet these requirements and can be used, such as second-generation cephalosporins and inhibitor-protected penicillins. Aminoglycosides should be reserved for patients at risk or allergic to b-lactams. Third and fourth generation cephalosporins, inhibitor-protected aminopenicillins and carbapenems should be used in isolated cases when the surgical site is contaminated with multi-resistant nosocomial microorganisms. Still, it is desirable that the use of these drugs be limited to the treatment of infections with a severe clinical course.

There are general principles of antibacterial therapy for UTIs in children, which include the following rules.

In case of febrile UTI, therapy should be started with a broad-spectrum parenteral antibiotic (inhibitor-protected penicillins, cephalosporins of the second and third generations, aminoglycosides).

It is necessary to take into account the sensitivity of urine microflora.

The duration of treatment for pyelonephritis is 14 days, cystitis - 7 days.

In children with vesicoureteral reflux, antimicrobial prophylaxis should be long-term.

Antibacterial therapy is not indicated for asymptomatic bacteriuria.

The concept of “rational antibiotic therapy” should include not only the correct choice of drug, but also the choice of its administration. It is necessary to strive for gentle and at the same time the most effective methods of prescribing antibacterial drugs. When using step therapy, which consists of changing the parenteral use of an antibiotic to an oral one, after the temperature has normalized, the doctor should remember the following.

• The oral route is preferable for cystitis and acute pyelonephritis in older children, in the absence of intoxication.
• The parenteral route is recommended for acute pyelonephritis with intoxication in infancy.

Antibacterial drugs are presented below depending on the route of their administration.

Oral medications for the treatment of UTIs.

1. Penicillins: amoxicillin + clavulanic acid.
2. Cephalosporins:

   II generation: cefuroxime;

   III generation: cefixime, ceftibuten, cefpodoxime.

Drugs for parenteral treatment of UTI.

1. Penicillins: ampicillin/sulbactam, amoxicillin + clavulanic acid.
2. Cephalosporins:

   II generation: cefuroxime (Cefu-rabol).

   III generation: cefotaxime, ceftriaxone, ceftazidime.

   IV generation: cefepime (Maxi-pim).

Despite the availability of modern antibiotics and chemotherapy drugs that make it possible to quickly and effectively cope with infection and reduce the frequency of relapses by prescribing drugs in low prophylactic doses for a long period, treating recurrent UTIs is still a rather difficult task. This is due to:

• increased resistance of microorganisms, especially when repeated courses are used;
• side effects of drugs;
• the ability of antibiotics to cause immunosuppression of the body;
• decreased compliance due to long courses of taking the drug.

As is known, up to 30% of girls have a recurrent UTI within 1 year, 50% within 5 years. In boys under 1 year of age, relapses occur in 15-20%; in boys older than 1 year, there are fewer relapses.

Let us list the indications for antibiotic prophylaxis.

• Absolute:

  a) vesicoureteral reflux;

  B) early age; c) frequent exacerbations of pyelonephritis (three or more per year), regardless of the presence or absence of vesicoureteral reflux.

• Relative: frequent exacerbations of cystitis.

The duration of antibiotic prophylaxis is most often determined individually. The drug is discontinued in the absence of exacerbations during prophylaxis, but if an exacerbation occurs after discontinuation, a new course is required.

Recently, a new drug has appeared on the domestic market to prevent recurrent UTIs. This preparation is a lyophilized protein extract obtained by fractionating an alkaline hydrolyzate of certain strains E. coli and is called Uro-Vaxom. The tests have confirmed its high efficiency with the absence of significant side effects, which gives hope for its widespread use.

An important place in the treatment of patients with UTIs is occupied by clinical observation, which consists of the following.

• Monitor urine tests monthly.
• Functional tests for pyelonephritis annually (Zimnitsky test), creatinine level.
• Urine culture - according to indications.
• Measure blood pressure regularly.
• For vesicoureteral reflux - cystography and nephroscintigraphy once every 1-2 years.
• Sanitation of foci of infection, prevention of constipation, correction of intestinal dysbiosis, regular bladder emptying.

Literature

1. Strachunsky L. S. Urinary tract infections in outpatients // Proceedings of the international symposium. M., 1999. pp. 29-32.
2. Korovina N. A., Zakharova I. N., Strachunsky L. S. et al. Practical recommendations for antibacterial treatment of urinary system infections of community-acquired origin in children // Clinical microbiology and antimicrobial chemotherapy, 2002. T. 4. No. 4. C 337-346.
3. Lopatkin N. A., Derevyanko I. I. Antibacterial therapy program for acute cystitis and pyelonephritis in adults // Infections and antimicrobial therapy. 1999. T. 1. No. 2. P. 57-58.
4. Naber K. G., Bergman B., Bishop M. K. et al. Recommendations of the European Association of Urology for the treatment of urinary tract infections and infections of the reproductive system in men // Clinical microbiology and antimicrobial chemotherapy. 2002. T. 4. No. 4. P. 347-63.
5. Pereverzev A. S., Rossikhin V. V., Adamenko A. N. Clinical effectiveness of nitrofurans in urological practice // Men's health. 2002. No. 3. pp. 1-3.
6. Goodman and Gilman's The Pharmacological Basis of Therapeutics, Eds. J. C. Hardman, L. E. Limbird., 10th ed., New York, London, Madrid, 2001.

S. N. Zorkin, Doctor of Medical Sciences, Professor
SCCD RAMS, Moscow

The risk of developing urinary tract infections in women depends on the age of the patient and the presence of concomitant diseases. In young and middle age, women get UTIs much more often than men, but then the likelihood of developing pathologies decreases.

The high incidence of ailments such as cystitis and pyelonephritis is explained by the structural features of the female body. This is not only the specific anatomy of the urethra, which facilitates the penetration of microbes inside, but also a number of other factors, including hormonal disorders and increased adhesion (sticking) of uropathogenic bacteria to the cells of the mucous membrane of the urinary tract.

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  Reasons for development

  The causes of urinary tract infections in women are very diverse. Most often, these diseases are bacterial in nature. Normally, the kidneys produce urine, which can be called sterile - it contains salts, water and metabolic products. When pathogenic bacteria enter the urethra, an inflammatory process called urethritis develops. Some bacteria move higher, enter the bladder and provoke the occurrence of cystitis.

  The most common pathogens are:

  • staphylococci;
  • enterococci;
  • Klebsiella;
  • coli.

  If inflammation in this organ is asymptomatic in the early stages and does not receive adequate treatment, the infection continues to spread higher, and after some time the risk of infection of the kidneys, or more precisely their tubular system, increases. This disease is called pyelonephritis, and the entire process described above is called an ascending infection of the genitourinary system.

  Diseases of the urinary system occur in both children and adults, more often at a young age.

  In order for bacteria to enter the ureters and other organs, appropriate conditions are necessary. Factors that provoke the development of UTI include:

  • inflammatory processes in the vagina;
  • hormonal disorders, due to which dysbiosis of the intestines and vagina develops (typical for pregnant women, but can also occur during other periods of a woman’s life, in particular during postmenopause);
  • genetic predisposition to such diseases;
  • too long use of oral contraceptives;
  • hypothermia and the presence of foci of chronic infection in the body (tonsillitis, tonsillitis).

  Types of UTIs

  All types of ailments of this type can be divided into two groups - complicated and uncomplicated UTIs. The first are observed in the presence of factors contributing to ascending infection:

  • congenital anomalies of the genitourinary system;
  • surgical interventions;
  • the formation of stones that impede the normal flow of urine;
  • insufficient emptying of the bladder (often observed in pregnant women).

  Complicated UTIs require elimination of the cause, that is, treatment of the underlying disease.

  Uncomplicated infections occur in young women who have unprotected sex, as well as in patients who neglect hygiene rules. Sometimes such pathologies develop in patients with diabetes.

  

  Main symptoms

  Although each type of disease has certain symptoms, there are common symptoms that apply to absolutely all UTIs. These include:

  • increased temperature due to the inflammatory process;
  • urinary disturbance;
  • increased sweating;
  • signs of general intoxication - weakness, dizziness, malaise;
  • pain in the affected organ, which can be sharp, dull, or bursting;
  • frequent urge to empty the bladder.

  Signs of a UTI are expressed with greater or lesser intensity depending on the severity of the disease in each individual patient.

  

  Cystitis and urethritis

  One of the most common infections of the urinary system is cystitis. About 25% of women experience this disease in an acute form, and every eighth of them suffers from a chronic form.

  Characteristic signs of acute cystitis are frequent urge to urinate (up to 50 times a day or even more), microhematuria, that is, the microscopic content of red blood cells in the urine. When the disease is advanced, it becomes cloudy. If the urine at the end of the process is stained with blood, this condition is called terminal macrohematuria. These manifestations are observed for 7-10 days, then the patient feels an improvement in her condition.

  Symptoms of cystitis are similar to urethritis. Moreover, in women, these diseases usually develop simultaneously and require the same therapy.

  Pyelonephritis

  Pyelonephritis is an inflammatory process in the kidneys, characterized by severe pain in the lumbar region. The acute form of the disease is dangerous due to the development of complications, which include carbuncle and kidney abscess.

  With purulent pyelonephritis, death is possible.

  Diagnostics

  The patients' complaints and symptoms are nonspecific, so it is necessary to isolate the specific pathogen and determine in which organ the inflammatory process develops.

  Methods such as bacterioscopic examination of vaginal microflora and general urine analysis are used. In addition, the degrees of bacteriuria, proteinuria and leukocyturia need to be assessed. A urine test is performed according to Nechiporenko, an Amburger study, etc.

  Sometimes UTIs develop against the background of gonorrhea, herpesvirus or mycoplasma infection. In this case, the doctor resorts to another test - the so-called polymerase chain reaction (PCR). Based on the identified pathogen, the specialist makes a diagnosis and gives appropriate recommendations regarding drug treatment, diet, etc.

  Drug treatment

  Treatment of UTIs in women mainly requires the use of antibiotics, which affect both gram-positive and gram-negative microflora. In most cases, it can be done at home, but severe pyelonephritis requires hospitalization. Antibiotics for illness are administered intravenously.

  If an analysis of the sensitivity of pathogenic microbes to drugs cannot be done for some reason, treatment is carried out with broad-spectrum agents. The drugs mainly used are from the group of cephalosporins - ceftriaxone (it is prescribed even during pregnancy, but only if the potential benefit outweighs the possible harm), cephalexin, cefuroxime and others.

  
  

  Medications that may be prescribed include:

  • semisynthetic penicillins (ampicillin, oxacillin, amoxicillin, Augmentin);
  • latest generation macrolides (clarithromycin, roxithromycin, azithromycin);
  • fluoroquinolones (ofloxacin, ciprofloxacin, levofloxacin).
  
  

  Not all broad-spectrum drugs are suitable for treating UTIs. For example, gentamicin, polymyxin and streptomycin have nephrotoxic properties, so if the infection is combined with kidney disease, these tablets are contraindicated.

  In modern conditions, the frequency of resistance of pathogenic microflora to antibiotics is constantly increasing. If treatment with one composition does not give the desired effect, another medicine is used. For example, there are strains of E. coli that are resistant to ampicillin. In such cases, nitrofurans (Furadonin, furazolidone) are prescribed. A positive result can be given by the drug nalidixic acid - nitroxoline.

  
  

  Phytolysin paste based on more than ten medicinal plants has proven itself to be positive. It has anti-inflammatory and antispasmodic properties. The drug is able to activate the process of dissolution of mineral salts, which helps prevent the formation of stones.

  Strengthening the body's natural immunity plays an important role. For this purpose, not only immunomodulators are prescribed, but also multivitamin complexes.

  Cystitis and pyelonephritis

  For cystitis, anti-inflammatory drugs are prescribed along with antibiotics, for example Cyston, which contains extracts of medicinal plants. It has diuretic properties, relieves inflammation in the urinary tract, and enhances the effect of antibiotic therapy. Designed for long-term use.

  For pyelonephritis, anti-inflammatory drugs of plant origin are also prescribed - for example, Canephron, containing extracts of rose hips, lovage, rosemary and centaury. It has a mild diuretic effect and increases the effectiveness of antibiotic use.

  

  Traditional therapy

  It is also possible to treat UTIs with folk remedies. These include:

  1. 1. Cranberry juice. It has antiseptic properties, flushes the urinary tract, suppresses the proliferation of pathogenic microbes, and helps remove toxic substances from the body. You should drink at least a glass of juice or cranberry juice a day.
  2. 2. Echinacea root infusion. It is brewed like tea (1 tablespoon per glass of boiling water) and drunk at least three cups per day.
  3. 3. Bearberry infusion. Also has antiseptic properties. The leaves of the plant are brewed in the standard way - 1 tbsp. l. per glass of boiling water. Take the medicine 1/3 cup three times a day in the acute period.
  4. 4. Nettle infusion. The product has a mild diuretic effect and helps eliminate bacteria along with urine. Prepare it once a day - 1 tsp. dry herbs are poured into a glass of boiling water, infused for 20-30 minutes, filtered and drunk after eating.

  Pharmacies sell milk thistle preparations, which contain ascorbic acid, tocopherol, retinol and B vitamins. They improve immunity and promote a speedy recovery of the patient.

One of the most common reasons for visiting a urologist today is genitourinary infections (UI), which should not be confused with STIs. The latter are transmitted sexually, while MPI is diagnosed at any age and occurs for other reasons.

Bacterial damage to the organs of the excretory system is accompanied by severe discomfort - pain, burning, frequent urge to empty the bladder, and the release of pathological secretions from the urethra. In severe cases of infection, intense febrile and intoxication symptoms may develop.

The optimal treatment option is the use of modern antibiotics, which allow you to get rid of the pathology quickly and without complications.

Genitourinary infections include several types of inflammatory processes in the urinary system, which includes the kidneys with the ureters (they form the upper sections of the urinary tract), as well as the bladder and urethra (lower sections):

• – inflammation of the parenchyma and pyelocaliceal system of the kidneys, accompanied by painful sensations in the lower back of varying intensity, as well as severe intoxication and febrile symptoms (lethargy, weakness, nausea, chills, muscle and joint pain, etc.).
• – an inflammatory process in the bladder, the symptoms of which are a frequent urge to urinate with an accompanying feeling of incomplete emptying, sharp pain, and sometimes blood in the urine.
• Urethritis is damage to the urethra (the so-called urethra) by pathogenic microorganisms, in which purulent discharge appears in the urine and urination becomes painful. There is also a constant burning sensation in the urethra, dryness and pain.

Urinary tract infections can have several causes. In addition to mechanical damage, pathology occurs against the background of hypothermia and decreased immunity, when opportunistic microflora is activated. In addition, infection often occurs due to poor personal hygiene, when bacteria enter the urethra from the perineum. Women get sick much more often than men at almost any age (with the exception of older people).

Antibiotics in the treatment of MPI

In the vast majority of cases, the infection is bacterial in nature. The most common pathogen is a representative of enterobacteria - Escherichia coli, which is detected in 95% of patients. Less common are S.saprophyticus, Proteus, Klebsiella, Entero- and.

The disease is also often caused by mixed flora (an association of several bacterial pathogens).

Thus, even before laboratory tests, the best option for genitourinary tract infections would be treatment with broad-spectrum antibiotics.

Modern antibacterial drugs are divided into several groups, each of which has a special mechanism of bactericidal or bacteriostatic action. Some drugs are characterized by a narrow spectrum of antimicrobial activity, that is, they have a detrimental effect on a limited number of varieties of bacteria, while others (broad spectrum) are designed to combat different types of pathogens. It is the antibiotics of the second group that are used to treat urinary tract infections.

Penicillins

The first antibiotics discovered by man were for quite a long time an almost universal means of antibiotic therapy. However, over time, pathogenic microorganisms mutated and created specific defense systems, which required the improvement of medications.

At the moment, natural penicillins have practically lost their clinical significance, and semi-synthetic, combined and inhibitor-protected penicillin antibiotics are used instead.

Urogenital infections are treated with the following drugs of this series:

• . A semi-synthetic drug for oral and parenteral use, acting bactericidal by blocking cell wall biosynthesis. It is characterized by fairly high bioavailability and low toxicity. Particularly active against Proteus, Klebsiella and Escherichia coli. In order to increase resistance to beta-lactamases, the combination drug Ampicillin/Sulbactam ® is also prescribed.
• . In terms of the spectrum of antimicrobial action and effectiveness, it is similar to the previous ABP, but is characterized by increased acid resistance (it is not destroyed in an acidic gastric environment). Its analogues and, as well as combined antibiotics for the treatment of the genitourinary system (with clavulanic acid) - Amoxicillin/Clavulanate ® , ® , are used.

Recent studies have revealed a high level of resistance of uropathogens to ampicillin and its analogues.

For example, the sensitivity of Escherichia coli is just over 60%, which indicates the low effectiveness of antibiotic therapy and the need to use antibiotics of other groups. For the same reason, the antibiotic sulfanilamide () is practically not used in urological practice.

Recent studies have revealed a high level of resistance of uropathogens to ampicillin ® and its analogues.

Cephalosporins

Another group of beta-lactams with a similar effect, differing from penicillins in increased resistance to the destructive effects of enzymes produced by pathogenic flora. There are several generations of these medications, most of them intended for parenteral administration. From this series, the following antibiotics are used to treat the genitourinary system in men and women:

• . An effective medicine for inflammation of all genitourinary organs for oral administration with a minimal list of contraindications.
• (Ceclor ® , Alphacet ® , Taracef ® ). It belongs to the second generation of cephalosporins and is also used orally.
• and its analogues Zinacef ® and. Available in several dosage forms. They can be prescribed even to children in the first months of life due to low toxicity.
• . Sold in powder form for the preparation of a solution, which is administered parenterally. Rocephin ® is also a substitute.
• (Cephobid ®). A representative of the third generation of cephalosporins, which is prescribed intravenously or intramuscularly for genitourinary infections.
• (Maxipim ®). The fourth generation of antibiotics of this group for parenteral use.

The listed drugs are widely used in urology, but some of them are contraindicated for pregnant and lactating women.

Fluoroquinolones

The most effective antibiotics to date for genitourinary infections in men and women. These are powerful synthetic drugs with bactericidal action (the death of microorganisms occurs due to disruption of DNA synthesis and destruction of the cell wall). They are considered highly toxic antibacterial agents. They are poorly tolerated by patients and often cause undesirable effects from the therapy.

Contraindicated in patients with individual intolerance to fluoroquinolones, patients with central nervous system pathologies, epilepsy, persons with kidney and liver pathologies, pregnant women, breastfeeding women, and patients under 18 years of age.

• . Taken orally or parenterally, it is well absorbed and quickly eliminates painful symptoms. It has several analogues, including Tsiprinol ®.
• ( , Tarivid ®). Antibiotic fluoroquinolone, widely used not only in urological practice due to its effectiveness and wide spectrum of antimicrobial action.
• (). Another drug for oral, as well as intravenous and intramuscular use. It has the same indications and contraindications.
• Pefloxacin ® (). It is also effective against most aerobic pathogens and is taken parenterally and orally.

These antibiotics are also indicated for mycoplasma, since they act on intracellular microorganisms better than the previously widely used tetracyclines. A characteristic feature of fluoroquinolones is their negative effect on connective tissue. It is for this reason that the drugs are prohibited from being used before reaching the age of 18, during pregnancy and breastfeeding, as well as by persons with diagnosed tendinitis.

Aminoglycosides

A class of antibacterial agents intended for parenteral administration. The bactericidal effect is achieved by inhibiting protein synthesis of predominantly gram-negative anaerobes. At the same time, drugs in this group are characterized by fairly high rates of nephro- and ototoxicity, which limits the scope of their use.

• . A drug of the second generation of aminoglycoside antibiotics, which is poorly adsorbed in the gastrointestinal tract and is therefore administered intravenously and intramuscularly.
• Netilmecin ® (Netromycin ®). Belongs to the same generation, has a similar effect and list of contraindications.
• . Another aminoglycoside that is effective for urinary tract infections, especially complicated ones.

Due to their long half-life, these drugs are used only once a day. Prescribed to children from an early age, but contraindicated for lactating women and pregnant women. First generation aminoglycoside antibiotics are no longer used in the treatment of urinary tract infections.

Nitrofurans

Broad-spectrum antibiotics for infections of the genitourinary system with a bacteriostatic effect, which manifests itself against both gram-positive and gram-negative microflora. At the same time, resistance in pathogens practically does not develop.

These drugs are intended for oral use, and food only increases their bioavailability. To treat UTI infections, Nitrofurantoin ® (trade name Furadonin ®) is used, which can be given to children from the second month of life, but not to pregnant and lactating women.

The antibiotic trometamol, which does not belong to any of the groups listed above, deserves a separate description. It is sold in pharmacies under the trade name Monural and is considered a universal antibiotic for inflammation of the genitourinary system in women.

This bactericidal agent for uncomplicated forms of inflammation of the urinary tract is prescribed in a one-day course - 3 grams of fosfomycin ® once (according to indications - twice). Approved for use at any stage of pregnancy, has virtually no side effects, and can be used in pediatrics (from 5 years of age).

Cystitis and urethritis

As a rule, cystitis and a nonspecific inflammatory process in the urethra occur simultaneously, so there is no difference in their treatment with antibiotics. For uncomplicated forms of infection, the drug of choice is.

Also, for uncomplicated infections in adults, a 5-7 day course of fluoroquinolones (Ofloxacin ® , Norfloxacin ® and others) is often prescribed. The reserve ones are Amoxicillin/Clavulanate ® , Furadonin ® or Monural ® . Complicated forms are treated similarly, but the course of antibiotic therapy lasts at least 1-2 weeks.

For pregnant women, the drug of choice is Monural ®; beta-lactams (penicillins and cephalosporins) can be used as an alternative. Children are prescribed a seven-day course of oral cephalosporins or Amoxicillin ® with potassium clavulanate.

Additional Information

It should be taken into account that complications and severe course of the disease require mandatory hospitalization and treatment with parenteral drugs. On an outpatient basis, medications are usually prescribed to be taken orally. As for folk remedies, they do not have any particular therapeutic effect and cannot be a substitute for antibiotic therapy. The use of herbal infusions and decoctions is permissible only in consultation with a doctor as an additional treatment.

According to the localization of the infection, the urinary tract is divided into infections of the upper (pyelonephritis, abscess and carbuncle of the kidneys, apostematous pyelonephritis) and lower sections of the urinary tract (cystitis, urethritis, prostatitis).

According to the nature of the infection, MEPs are divided into uncomplicated And complicated . Uncomplicated infections occur in the absence of obstructive uropathy and structural changes in the kidneys and urinary tract, as well as in patients without serious concomitant diseases. Patients with uncomplicated urinary tract infections are often treated on an outpatient basis and do not require hospitalization. Complicated infections occur in patients with obstructive uropathy, against the background of instrumental (invasive) methods of examination and treatment, and serious concomitant diseases (diabetes mellitus, neutropenia). Any UTI infections in men are interpreted as complicated.

It is important to distinguish between community-acquired (occurs in an outpatient setting) and nosocomial (develops after 48 hours of a patient’s hospital stay) UTI infections.

MAIN PATIENTS

Uncomplicated infections MVP in more than 95% of cases are caused by one microorganism, most often from the family Enterobacteriaceae. The main causative agent is E.coli- 80-90%, much less often S. saprophyticus (3-5%), Klebsiella spp., P.mirabilis etc. When complicated infections MVP release frequency E.coli decreases, other pathogens are more common - Proteus spp., Pseudomonas spp., Klebsiella spp., mushrooms (mainly C.albicans). Renal carbuncle (cortical abscess) is caused in 90% by S. aureus. The main causative agents of apostematous pyelonephritis, kidney abscess with localization in the medullary substance are E. coli, Klebsiella spp., Proteus spp.

As with other bacterial infections, the sensitivity of pathogens to antibiotics is critical when choosing a drug for empirical therapy. In Russia, in recent years, there has been a high frequency of resistance of community-acquired strains E.coli to ampicillin (uncomplicated infections - 37%, complicated - 46%) and co-trimoxazole (uncomplicated infections - 21%, complicated - 30%), therefore these AMPs cannot be recommended as drugs of choice for the treatment of UTI infections. Resistance of uropathogenic strains of Escherichia coli to gentamicin, nitrofurantoin, nalidixic acid and pipemidic acid is relatively low and amounts to 4-7% for uncomplicated and 6-14% for complicated MVP. The most active are fluoroquinolones (norfloxacin, ciprofloxacin, etc.), the level of resistance to which is less than 3-5%.

CYSTITIS

ACUTE UNCOMPLICATED CYSTITIS

Drugs of choice: oral fluoroquinolones (levofloxacin, norfloxacin, ofloxacin, pefloxacin, ciprofloxacin).

Alternative drugs: amoxicillin/clavulanate, fosfomycin trometamol, nitrofurantoin, co-trimoxazole.

Duration of therapy: in the absence of risk factors - 3-5 days. Single-dose therapy is inferior in effectiveness to 3-5-day courses. Only fosfomycin trometamol is used once.

ACUTE COMPLICATED CYSTITIS

Acute complicated cystitis or the presence of risk factors(age over 65 years, cystitis in men, persistence of symptoms for more than 7 days, recurrence of infection, use of vaginal diaphragms and spermicides, diabetes mellitus).

Choice of antimicrobials

Alternative drugs: oral cephalosporins of the II-III generation (cefuroxime axetil, cefaclor, cefixime, ceftibuten), co-trimoxazole.

Duration of therapy: 10-14 days.

SEVERE AND COMPLICATED PYELONEPHRITIS

Hospitalization required. Treatment, as a rule, begins with parenteral drugs, then, after normalization of body temperature, they switch to oral antibiotics.

Choice of antimicrobials

Drugs of choice: parenteral fluoroquinolones amoxicillin/clavulanate, ampicillin/sulbactam.

Alternative drugs: parenteral cephalosporins II-IV generation cefoperazone/sulbactam, ticarcillin/clavulanate, ampicillin + aminoglycoside carbapenems (imipenem, meropenem).

Duration of therapy: Parenteral antibiotics until fever resolves, then switch to oral antibiotics as for mild to moderate pyelonephritis. The total duration of antimicrobial therapy should be at least 14 days and determined by the clinical and laboratory picture.

APOSTEMATOUS PYELONEPHRITIS, KIDNEY ABSCESS

Therapy is carried out in a specialized urological hospital. If necessary, surgical treatment.

Choice of antimicrobials

Cortical abscess

Abscess of the medullary substance, apostematous pyelonephritis

Drugs of choice: parenteral fluoroquinolones (levofloxacin, ofloxacin, pefloxacin, ciprofloxacin), amoxicillin/clavulanate, ampicillin/sulbactam.

Alternative drugs: parenteral cephalosporins of the II-IV generation (cefuroxime, cefotaxime, ceftriaxone, cefoperazone, cefepime), cefoperazone/sulbactam, ticarcillin/clavulanate, ampicillin + aminoglycosides (gentamicin, netilmicin, amikacin), carbapenems (imipenem, meropenem).

Duration of therapy: 4-6 weeks, determined by clinical and laboratory picture. The first 7-10 days are parenteral, then a transition to oral administration of AMPs is possible.

FEATURES OF TREATMENT OF UTI INFECTIONS IN PREGNANCY

Alternative drugs: nitrofurantoin.

Duration of therapy: 7-14 days.

PYELONEPHRITIS

Alternative drugs: aminoglycosides, ampicillin, amoxicillin ampicillin/sulbactam, aztreonam.

Duration of therapy: at least 14 days.

FEATURES OF TREATMENT OF UTI INFECTIONS DURING BREASTFEEDING

During breastfeeding, the use of fluoroquinolones is contraindicated, and the use of co-trimoxazole is undesirable during the first 2 months of breastfeeding. If it is impossible to carry out alternative therapy, the above drugs may be prescribed when transferring the child to artificial feeding for the period of treatment.

FEATURES OF TREATMENT OF UTI INFECTIONS IN ELDERLY PEOPLE

In older people, the incidence of UTI infections increases significantly, which is associated with complicating factors: benign prostatic hyperplasia in men and a decrease in estrogen levels in women during menopause. Therefore, treatment of UTI infections should include not only the use of antimicrobial agents, but also the correction of the described risk factors.

For benign prostatic hyperplasia, drug or surgical treatment is carried out; in women during menopause, local vaginal use of estrogen drugs is effective.

Kidney function in older people is often reduced, which requires special caution when using aminoglycosides. There is a high incidence of adverse reactions with the use, especially long-term, of nitrofurantoin and co-trimoxazole. Therefore, these drugs should be prescribed with caution.

FEATURES OF TREATMENT OF UTI INFECTIONS IN CHILDREN

The spectrum of pathogens in children does not differ from that in adults. The leading pathogen is E.coli and other members of the family Enterobacteriaceae. In case of moderate and severe pyelonephritis, children in the first 2 years of life are recommended to be hospitalized. Usage

Our body is constantly exposed to attacks from various aggressive microorganisms, viruses and other particles. Fortunately, in most cases they do not lead to the development of diseases, because over many years of existence, the human immune system has learned to cope with aggressors without harm to health. But sometimes the activity of the protective forces is not enough, in which case various ailments may occur. Thus, representatives of the fair sex quite often seek doctor’s help due to the development of infectious lesions of the genitourinary system. Their therapy can be carried out using a variety of medications. So, the topic of our conversation today on this page “Popular about health” will be infections of the genitourinary system in women, the treatment of which with drugs will be discussed further.

Infectious lesions of the urinary and genital tracts are two groups of diseases that are closely related to each other. They can be provoked by the same type of infectious agents, including bacteria, protozoa, viruses and fungi. Inflammatory lesions can be nonspecific; in this case, they develop during the activity of saprophytic or obligate flora. Its representatives are streptococci, staphylococci, E. coli and Candida fungi. In addition, infections can be of a specific nature, in which case they are caused by bacteria represented by mycoplasmas, ureaplasmas, gonococci, and spirochete pallidum.

Other similar diseases of the genitourinary system in women include chlamydia, caused by protozoa, which have the properties of bacteria and viruses at the same time. And viral diseases are represented by HPV () and genital herpes.

Drug treatment of genitourinary tract infections in women

Therapy for diseases depends solely on their causative agent, and is selected by doctors after conducting a series of laboratory tests. Antibiotics help to cope with bacterial infections, antifungal agents are used to correct fungal diseases, and antiviral agents are used to treat viruses. Treatment may also involve the use of antiprotozoal medications, antiseptics, immunostimulants, etc.

Antibacterial drugs for the treatment of the genitourinary system in women

Antibiotics effectively suppress the activity of pathogens of many genitourinary infections. They are selected by the doctor, focusing on the type of disease and the results of the studies performed. The duration of antibiotic therapy can vary from several days to several weeks. It depends on the characteristics of the chosen medicine. Most often, therapy with antibacterial drugs is carried out for seven to ten days.

The following antibiotics can be used in the treatment of genitourinary infections:

Penicillin antibiotics (represented by oxacillin, amoxicillin, ampicillin, amoxicillin clavulonate, ampiox, etc.);

Cephalosporins (represented by cefuroxime, cefixime, cefazidime, cefepime, etc.);

Fluoroquinolones (represented by ofloxacin, lomefloxacin, norfloxacin, lefloxacin, etc.);

Macrolides (represented by clarithromycin, azithromycin, josamycin);

Aminoglycosides (represented by streptomycin, neomycin, sisomycin, gentamicin, amikacin, etc.);

Tetracyclines (represented by tetracycline, oxytetracycline, chlortetracycline).

To correct chlamydial infections, macrolides and fluoroquinolones are most often used; mycoplasma is treated with tetracyclines; detected gonococci are an indication for the use of azithromycin, cephalosporins, penicillins, fluoroquinolones or aminoglycosides. As for ureaplasma, it is sensitive to azithromycin or doxycycline.

Nitrofurans - drugs for the genitourinary system

In some cases, doctors prefer nitrofurans rather than antibiotics. Such drugs are represented by nitrofurantoin (Nifurtoinol and Furadonin), as well as furazidine (Furomax and Furomag).

Antiviral drugs

To correct viral lesions, medications that can suppress viruses can be used. These can be antiherpetic drugs, for example, acyclovir, valacyclovir or penciclovir. Doctors can also prescribe other medications to their patients that suppress the activity of viruses, for example, Orvirem, Arbidol, Repenza, Ingavirin, etc.

The group of antiviral drugs also includes interferon drugs, which block the processes of translation of viral RNA. They are represented by Viferon, Interferon, Grippferon and Kipferon.

Sometimes treatment is carried out using interferon inducers, which are designed to activate the production of one's own interferon.

Antifungal drugs for women

Two groups of antifungal drugs can be used in the treatment of genitourinary infections. These are systemic azoles that suppress the activity of fungi, they are represented by ketoconazole, fluconazole, flucostat, mycosist, etc. Doctors can also use so-called antifungal antibiotics, including nystatin, pimafucin and levorin.

Antiprotozoal drugs

This group of drugs includes metronidazole, which is usually prescribed to patients with trichomoniasis.

We looked at how to treat infections in women, treatment with certain drugs. In addition to them, other drugs are used that have additional antiseptic, immunostimulating, and supporting effects. All of them are selected by the doctor on an individual basis.