Cystitis is a common condition mainly affecting women; however, it can also affect men and children. Mild cystitis is usually a self-limiting condition, meaning it will go on its own. Some patients may need to see their GP, depending on symptoms and their duration. Treatment of cystitis over the counter involves pain management with commonly available analgesics and the symptomatic management with products available from a pharmacy and other stores. Patients may also use different private services to obtain prescription-only treatment (antibiotics) without seeing a GP (NHS). In this post, I will summarise options available for the treatment of cystitis:
- Over the counter product for the management of symptoms
- Review of private services offered by UK pharmacies to supply antibiotic for cystitis without seeing a GP
What is cystitis?
Cystitis is defined as the inflammation of the bladder, which is usually caused by a bacterial infection. Other causes of cystitis may also include the use of scented soaps or irritation from sex. Cystitis is the most common type of urinary tract infection (UTI).
Symptoms of cystitis
The main symptoms associated with cystitis:
- Burning sensation when weeing (passing the urine)
- Pain on urination
- Pain in the lower tummy
- Passing the urine more frequently or wanting to pee after urination
- Needing to pee more urgently
- Urine which is dark or cloudy colour, which can also be smelling
Cystitis: Who need to see GP?
The following groups of patients are advised to see their GP when experiencing symptoms of cystitis:
- Men (cystitis is much less common in men)
- Pregnant women
- Symptoms lasting longer than three days
- Symptoms getting worse (cystitis can lead to kidney infection)
- Patients with severe symptoms such as concomitant high temperature or blood in the urine
- Patients who get cystitis often
Self-care measures recommended in the management of cystitis:
- Drinking plenty of fluids, preferably water or drinks which do not contain caffeine or sugar
- No evidence exists to support the use of cranberry juice or cranberry products to improve the symptoms of cystitis
How to reduce the risk of getting cystitis?
Reducing the risk of cystitis, for example:
- After using the toilet wipe from the front (vagina) to the back (bottom)
- Empty bladder after having sex
- Drinking plenty of fluids throughout the day
- Avoiding perfumed soaps and bubble bath
Treatment of cystitis over the counter: pain management
Patients are advised to use simple analgesia for pain relief related to cystitis. Over the counter painkillers which can be used include:
- Ibuprofen (if suitable)
Treatment of cystitis over the counter
Over the counter products used in the treatment of cystitis are used to manage symptoms of mild cystitis. Patients with symptoms which persist after a two-day course with over the counter product for cystitis or symptoms which worsen should speak to a doctor.
Where can you buy products for cystitis?
Most pharmacies and larger grocery stores sell products for cystitis. The number of products can also be purchased online on Amazon and other websites. Although I review the use of the two most popular cystitis products, there are plenty of other brands available online and from pharmacies containing the same active ingredients.
Options for over the counter treatment of cystitis
Products used in the management of cystitis make the urine less acidic, helping with cystitis symptoms such as painful urination, burning, and stinging. Two main ingredients used in cystitis relief products include:
- Potassium citrate
- Sodium citrate
Neither of the products has antibiotics properties. Additionally, there is little evidence to support their effectiveness.
Products used to relieve cystitis symptoms come in the form of powders, which are mixed with water.
CanesOasis for management of cystitis
- 48hr complete course of treatment
- CanesOasis is specially designed to provide effective relief from the stinging and burning of cystitis
- CanesOasis is specially designed to provide effective relief from the symptoms of cystitis
CanesOasis comes in the form of granules (cranberry flavour), which contain sodium citrate.
CanesOasis age restrictions
Patients must be 16 years of age to purchase the product. CanesOasis should not be used by children or by men.
How to take CanesOasis?
One sachet three times a day for two days. Mix content of sachet with water.
Can anyone use CanesOasis?
Customers who are allergic to sodium citrate should not use CanesOasis.
Sodium citrate should not be used by patients with:
- high blood pressure
- heart disease
- history of kidney disease
- pregnant women
- patient on a low sodium (salt) diet
Cystopurin Granules for cystitis
Cystopurin is another popular brand of cystitis relief products. Cystopurin comes in the form of granules. When mixed with water, a cranberry flavoured drink is formed.
- Granular powder, flavoured with cranberry extract
- Suitable for adults, elderly and children over 6 years
- Effective relief from the symptoms of cystitis
Cystopurin contains potassium citrate, which is an alternative option to previously discussed sodium citrate. Cystopurin is a low sodium preparation, which may be a better option for patients who seek low-sodium products.
Cystopiurin: age restrictions
Adults and children over six years of age can use Cystopurin. Children over six years of age should only use Cystopurin after the advice from a doctor.
Can anyone use Cystopurin?
Patients with a history of kidney disease and patients allergic to potassium citrate should not use Cystopurin. Patients who take ACE inhibitors (e.g., ramipril) and potassium-sparing diuretics (e.g., amiloride) should consult their doctor before using Cystopurin. Generally, patients who take those drugs should not use potassium preparations due to the risk of hyperkalaemia (high potassium levels).
Cystopiurin is not recommended during pregnancy or breast-feeding unless advised by a doctor.
How to take Cystopiurin?
Cystopiurin granules should be mixed with water. One sachet should be taken three times a day for two days.
Private services for the treatment of cystitis
Can you get antibiotics over the counter for the treatment of cystitis?
Generally, you can’t get over the counter antibiotics for treatment of cystitis. However, there are few options offered by pharmacies in the form of private services, which may allow patients to buy antibiotics without seeing a GP.
Boots Cystitis Test & Treat Service
Boots offer a private service for testing and treatment of UTIs, including the supply of prescription-only medication without seeing a GP.
In a nutshell, patients need to purchase a Dip UTI test kit online or from Boots pharmacy (£10) and complete the urine dipstick test. Patients need to download an app and follow the instructions from the app. The test takes a few minutes only.
Once the test is completed, patients need to see a pharmacist in one of Boots stores to discuss the results. If appropriate, a pharmacist can offer the supply of prescription-only antibiotic for which the patient needs to pay (£15).
Superdrug cystitis treatment
Superdrug’s cystitis service is aimed at women aged under 65. In contrast to Boots cystitis service, Superdrug requires the patient to answer a short questionnaire to get antibiotic treatment.
As a part of the treatment, Superdrug offers a three-day course with MacroBid® antibiotic. MacroBid® is a brand of nitrofurantoin antibiotic, currently recommended as a first-line treatment of UTI in the UK. MacroBid® comes in the form of modified-release capsules, which are usually taken twice a day.
Patients are also able to order antibiotic treatment for future use in case they experience symptoms of cystitis.
Patients can choose to ‘click and collect‘ the treatment from Superdrug Pharmacies, or choose delivery instead.
Superdrug’s cystitis treatment costs £25, which includes 6 MacroBid® 100mg capsules (3-day course).
The usual dose for treatment of cystitis with MacroBid®:
- Take one capsule twice a day for three days
Lloyds Pharmacy Cystitis treatment
Lloyds Pharmacy offers a three-day course/treatment of cystitis also with MacroBid® antibiotic as a part of Online Doctor services. Patients who cannot take MacroBid® (nitrofurantoin) may choose an alternative treatment with trimethoprim, another antibiotic.
Patients need to complete a short online questionnaire with the answers reviewed by one of the clinicians. When approved, patients can collect their medication from selected Lloyds Pharmacy branch.
Cost of the service: £23.99 for a three-day course with MacroBid®.
Treatment of cystitis with ‘Online Doctor’ services
There are many websites which offer private online consultations with doctors. Some patients may have access to online doctor services trough private healthcare with their employers. However, services like Push Doctor (and many others), for example, are accessible to the general public.
Patients may obtain a private prescription to treat cystitis with an antibiotic after a consultation with a doctor.
Overall, this option may add up to a higher cost of the treatment, but it will depend on whether one already has access to private services and at what price.
The treatment’s total cost would be equal to the cost of a consultation with a doctor + prescription fee (may be included in the cost of service) + cost of drug supplied by pharmacy.
When a private prescription is brought to a pharmacy, the patient needs to pay for the cost of medication and any additional markup (which may be 20% or more on top of the drug cost). For a 3 day course with MacroBid capsules, patients may expect to pay around £6 (price will vary between pharmacies). Some pharmacies may have a minimum charge for supplying drugs on private prescriptions, which may be more than £6.
Conclusion: what is the best treatment for cystitis?
Cystitis is a self-limiting condition in many cases. Patients with mild symptoms can use over the counter painkillers to help with pain and products containing potassium or sodium citrate.
Antibiotics are effective in the treatment of cystitis and UTIs. Out of three options discussed, Superdrug Pharmacy and Lloyds Pharmacy offers the antibiotic treatment with no test to confirm a bacterial infection. This may be the most convenient and fastest way of getting an antibiotic without seeing a doctor.
Patients need to be aware that antibiotic treatment for cystitis is not always required. Overuse of antibiotics can lead to antibiotic resistance, which means that in long term antibiotics become less effective in the treatment of infections (PHE, n.d.).
Public Health England, PHE (n.d.). Treating your infection – urinary tract infection (UTI). Available at: https://www.prescqipp.info/umbraco/surface/authorisedmediasurface/index?url=%2fmedia%2f3162%2ftreating-your-infection-uti.pdf Accessed on 26/06/2020