Treatment of Recurrent Cystitis in Women: Managing Three or More Episodes per Year
This protocol addresses recurrent cystitis specifically in women who experience three or more episodes per year, or two or more episodes within any six-month period. The pattern of recurrence in this population warrants a structured preventive strategy beyond episode-by-episode treatment.
Female sex is a key defining factor in this protocol. Recurrent cystitis is defined by at least three episodes per year or two episodes in the last six months. Menopausal status influences which preventive options are appropriate, as the underlying susceptibility factors differ between pre-menopausal and post-menopausal women.
The protocol centres on non-antibiotic prevention. Available options span behavioural, hormonal, and supplemental interventions — with the choice guided by menopausal status and individual factors. The full structured regimen specifies which options apply and under what conditions.
Full regimen, selection criteria, and sequencing available via the protocol link below.References
- Recurrent cystitis is defined by at least three episodes of cystitis per year or two episodes of cystitis in the last six months.
- Advise pre-menopausal women regarding increased fluid intake, as it might reduce the risk of recurrent cystitis.
- Use vaginal oestrogen replacement in post-menopausal women to prevent recurrent cystitis.
- Advise patients on the use of cranberry products for symptom relief in acute cystitis and to prevent recurrence; however, patients should be informed that the quality of evidence underpinning this is low with contradictory findings.
- Use D-mannose to reduce recurrent cystitis episodes, but patients should be informed of the overall weak and contradictory evidence of its effectiveness.
- Use methenamine hippurate to reduce recurrent cystitis episodes in women without abnormalities of the urinary tract.
- Advise patients on the use of a local or oral probiotic containing strains of proven efficacy for vaginal flora regeneration to prevent cystitis.
- Advise patients on the use of a combination of xyloglucan, hibiscus and propolis, or Centaurii herba, Levistici radix and Rosmarini folium to reduce recurrent cystitis episodes and reduce antibiotic use.