Chronic UTI patients and clinicians have warned of National Institute for Health and Care (NICE) guidelines discouraging primary care physicians from treating or prescribing drugs for patients with “mild cystitis.”
When patients are deemed to have “mild cystitis,” they are forced to use ineffective over-the-counter medications to treat it, putting them at risk of developing a chronic urinary tract infection (UTI), a leading physician said.
For many patients who develop UTI, their experience is extremely painful but short-lived. But for thousands of others, a single acute attack turns into a chronic infection that takes over their lives and lasts for months or even years.
Bladder infection specialist Dr. Cat Anderson said failing to fully assess every patient who shows symptoms of cystitis — no matter how mild — means that a possible recurrent or chronic bladder infection “goes one step further.”
She said i that the terms “cystitis” and “UTI” usually refer to the same thing: a bladder infection.
“Mild cystitis” is on the list of conditions that doctors can no longer prescribe, along with sunburn, head lice and motion sickness.
This is due to a revision of the NICE guidelines in 2018, which prevented patients from receiving prescriptions for over-the-counter medicines for a range of minor health conditions.
dr. Anderson said OTC medications for “mild cystitis” include alkalizing powders, which make urine that comes in contact with the inflamed bladder surface feel comfortable rather than treating the infection itself.
“I think there is a risk that it makes the patient more comfortable to tolerate their symptoms for longer, giving any bacteria present a greater chance of causing an embedded infection,” she said.
NICE guidelines have also been amended in recent years to advise doctors to consider a 48-hour delay before prescribing antibiotics to women with UTI symptoms — just in case the symptoms clear up during that time.
dr. Anderson described these changes as “a terrible setback” that “has resulted in lifelong misery for quite a few patients” who eventually develop a chronic infection from lack of effective treatment.
What is ‘mild cystitis’?
dr. Anderson said that “mild cystitis” probably means “people who present with only a little bit of increased frequency and only a little bit of discomfort.”
However, she added that this is a “complex disease area” and that talking about “mild cystitis” in the NICE guidelines is an “oversimplification”.
“By the way, they can’t predict which cases will evolve into the more severe cases.” [cystitis] presents in the first place,” she said.
Some bladder infections are easily resolved with a three-day course of antibiotics, while others are much more challenging and require long-term treatment in a specialist clinic.
Can you have a bladder infection without a urinary tract infection?
Some experts say you can have cystitis without an infection present, while others disagree.
There is a condition called bladder pain syndrome or interstitial cystitis, which theoretically is cystitis with no infection present.
Key experts, including Dr. Anderson, however, argue that interstitial cystitis is much less common than previously expected, and that “most cases of chronic cystitis are actually an infection that has been misdiagnosed.”
Leah Herridge, a campaigner who has suffered from a chronic urinary tract infection herself, said the inclusion of “mild cystitis” on the list of conditions for which doctors cannot prescribe “plays down” the disease.
The 35-year-old from London said the terminology seems “really dangerous” as it could lead GPs not to take the condition seriously.
“It could affect the way doctors respond to women with UTI infection, perhaps decreasing the likelihood of diagnosis and treatment, while increasing the likelihood of repeat infection and thus the percentage of women who develop chronic UTIs,” she said. . i.
Ms Herridge also expressed concern that women who develop a urinary tract infection could reject the condition themselves and not seek appropriate treatment until the infection has become recurrent or chronic.
As part of her campaign, Ms Herridge is demanding that the government take women’s health concerns seriously. The revision of the NICE guidelines in 2018, she said, is a “step in the wrong direction”.
A spokesperson for the Ministry of Health and Social Care said: “We are committed to ensuring that everyone gets the high-quality care they need, regardless of their gender, and we plan to update our women’s health strategy later this year. to tackle gender inequalities in health. †