Long-Term Antibiotics for Disturbed Bladder Microbiome Disorders

Abstract

Introduction and hypothesis: In recent years, there has been significant progress in understanding bladder disorders and their connection to the bladder microbiome. Emerging evidence suggests that the bladder microbiome, which is unique to each individual, plays a pivotal role in maintaining bladder health. Disruptions to the normal microbiome composition have been associated with various pathological conditions such as recurrent urinary tract infections, interstitial cystitis, and chronic recalcitrant cystitis.

Methods: We completed a focused literature review to collect studies that evaluated the use of antibiotics for long-term treatment (more than 28 days) of infectious/inflammatory disturbed bladder microbiome DBM disorders. RESULTS: This article reviews current literature on the composition of the bladder microbiome, describes the disorders associated with DBM, explores the utility of long-term antibiotics in managing DBM, and foresees future venues for DBM disorders research.

Conclusion: This review has demonstrated encouraging outcomes regarding the use of long-term antibiotics in managing infectious disorders of DBM, such as recurrent urinary tract infections and chronic recalcitrant cystitis, while no benefit was seen in interstitial cystitis patients. The studies showed that long-term cephalexin, fluoroquinolones, and fosfomycin are well-tolerated and effective options, with cephalexin being favored given its low side-effect profile.

Keywords: Bladder health; Cefazolin; Fosfomycin; Lower urinary tract symptoms; Management; Trimethoprim.