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June 27, 1977

Recurrent Cystitis

JAMA. 1977;237(26):2813. doi:10.1001/jama.1977.03270530021009

To the Editor.—  The advice of the consultant on the best treatment for recurrent cystitis (236:2546, 1976) contains some important errors.

  1. According to the reply, the optimal treatment for cystitis is one to three months of antibiotic therapy. While prolonged antibiotic therapy may be necessary for relapsing pyelonephritis, most cases of "chronic" cystitis are really reinfections.1 The therapeutic problem lies not in sterilizing the urine, which can be done with a short course of an appropriate antibiotic (235:1854, 1976), but in preventing reinfection.

  2. It is stated that the entrance of bacteria into the bladder during bathing is an important factor in producing cystitis. Introducing bacteria in large titers into the bladders of normal humans has not produced cystitis or pyuria, and the urine has been sterilized spontaneously within 72 hours.2 A compromise of the bladder's defense to bacterial invasion is undoubtedly important in the pathogenesis of