title: Is intravesical instillation of hyaluronic acid and chondroitin sulfate useful in preventing recurrent bacterial cystitis? A multicenter case control analysis.
abstract: OBJECTIVE
  Urinary tract infections (UTIs) are common in the female population and, over a lifetime, about half of women have at least one episode of UTI requiring antibiotic therapy. The aim of the current study was to compare two different strategies for preventing recurrent bacterial cystitis: intravesical instillation of hyaluronic acid (HA) plus chondroitin sulfate (CS), and antibiotic prophylaxis with sulfamethoxazole plus trimethoprim.
  
  
  METHODS
  This was a retrospective review of two different cohorts of women affected by recurrent bacterial cystitis. Cases (experimental group) were women who received intravesical instillations of a sterile solution of high concentration of HA + CS in 50 mL water with calcium chloride every week during the 1(st) month and then once monthly for 4 months. The control group included women who received traditional therapy for recurrent cystitis based on daily antibiotic prophylaxis using sulfamethoxazole 200 mg plus trimethoprim 40 mg for 6 weeks.
  
  
  RESULTS
  Ninety-eight and 76 patients were treated with experimental and control treatments, respectively. At 12 months after treatment, 69 and 109 UTIs were detected in the experimental and control groups, respectively. The proportion of patients free from UTIs was significantly higher in the experimental than in the control group (36.7% vs. 21.0%; p = 0.03). Experimental treatment was well tolerated and none of the patients stopped it.
  
  
  CONCLUSIONS
  The intravesical instillation of HA + CS is more effective than long-term antibiotic prophylaxis for preventing recurrent bacterial cystitis.
authors.affiliation: Urogynecology Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gugliotta
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital "P. Giaccone", Palermo, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Calagna
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital "P. Giaccone", Palermo, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Adile
authors.affiliation: Department of Obstetrics and Gynecology, "Barone I. Romeo" Hospital, Patti (Messina), Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Polito
authors.affiliation: Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Saitta
authors.affiliation: Urogynecology Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Speciale
authors.affiliation: Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova of Reggio Emilia, Reggio Emilia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Palomba
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital "P. Giaccone", Palermo, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Perino
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital G. Martino, Messina, Italy. Electronic address: rgranese@unime.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Granese
authors.affiliation: Urogynecology Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Adile
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000283:Administration, Intravesical; D000328:Adult; D002809:Chondroitin Sulfates / Q000008:administration & dosage*; D003556:Cystitis / Q000382:microbiology / Q000517:prevention & control* / Q000652:urine; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007322:Instillation, Drug; D012008:Recurrence; D012189:Retrospective Studies; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000382:microbiology / Q000517:prevention & control* / Q000652:urine
chemical_list: D000276:Adjuvants, Immunologic; D006820:Hyaluronic Acid; D002809:Chondroitin Sulfates
keywords: antibiotics; chondroitin sulfate; cystitis; hyaluronic acid