La cistitis en la era del antibiótico.

Es difícil para el ser humano de hoy en día, poder imaginarnos como debió ser el tratamiento de las enfermedades infecciosas de nuestros antepasados en la era preantibiótica. Se puede decir que la história de los antibióticos empieza con el descubrimiento de la penicilina en 1928, por Alexander Fleming, Su descubrimiento marcó un antes y un después en el tratamiento de las infecciones, aunque se debió de esperar al cercano 1941 para tratar con penicilina purificada al primer ser humano.
La cistitis o la infección de la orina de la vejiga urinaria, es tal vez, la enfermedad infecciosa con un claro predominio femenino desde casi el origen de la noche de los tiempos. Se manifiesta por la sensación de quemazón al orinar, dolor en el bajo vientre, la incómoda polaquiuria o aumento de la necesidad de acudir al baño, y en algunos casos fiebre.
Cerca de la mitad de las mujeres sufren un infección de las vías urinarias en algún momento de su vida, y un 30 por ciento presentaran recaídas; son las llamadas infecciones urinarias de repetición.
El tratamiento antibiótico no suele solucionar el problemas de la infecciones que se repiten, pues los antibióticos actúan de forma puntual, y las vejigas de las mujeres afectas de recaídas infecciosas de su orina presenta un déficit inmunitario de las mucosas.
La mayoría de las mujeres que padecen cistitis desconocen que el agente causal es una bacteria procedente de su flora intestinal, siendo el germen Escherichia coli el identificado en el 80-90% de los casos.
Una vez hecho el diagnóstico y preguntado a la paciente si presenta algún escape de orina, es cuando se procederá al tratamiento con una buena hidratación, un antibiótico y medidas sintomáticas acompañantes
La guía de práctica clínica Cistitis no complicada en la mujer, promovida por la Asociación Española de Urología, recomienda como fármaco de primera elección la fosfomicina trometamol en dosis única de 3 g o pauta corta de dos dosis.
Los factores que favorecen el desarrollo de las cistitis en las mujeres pueden ser razones anatómicas, como la uretra es más corta que favorece la transmisión de bacterias desde el exterior hacia el tracto urinario. Además la distancia entre el orificio de salida de la uretra, la entrada de la vagina y el orificio de salida del intestino es muy corta y esto facilita que entren bacterias intestinales a la uretra, por ejemplo durante el acto sexual.
Otras causas que pueden que favorecen la infección son algunas medidas anticonceptivas de colocación vaginal (espermicida, diafragma), embarazo, diabetes mal controlada, abuso de lavado genital. Los inevitables cambios en la flora microbiana en las mujeres durante la menopausia y un vaciado completo de la vejiga pueden incrementar también el riesgo de contaminación del aparato urinario.
Las medidas preventivas son fáciles de cumplir exigiendo tan solo una cierta autodisciplina y concienciación.
En el caso del zumo o derivados de arándonos tomado diariamente. Se basa en su efecto antiadherente de los germenes a la mucosa vesical disminuyendo las posibilidades de infección o recaída. Se ha de prevenir de la interferencia de este fruto con los antiagregantes y anticoagulantes que puede tomar la persona.
Aunque es saludable para el organismo estar bien hidratados, recientes estudios han señalado que las conductas de beber más agua y orinar enseguida después del coito no suponen una diferencia respeto al desarrollo de una infección de orina. Por otra parte, es recomendable limpiarse con papel seco a contracorriente (de adelante atrás) después de evacuar el intestino, tomar fibra regularmente para remediar el estreñimiento, evitar la higiene genital obsesiva y frecuente y las humedades que comportan una proliferación microbiana, como es el caso en verano de un bañador utilizado durante mucho tiempo en la playa o la misma sudoración.

Dr. Joaquim Gironella Coll

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