Microorganism in Overactive Bladder Patients
Condition: Overactive Bladder
MeSH terms: Urinary Bladder, Overactive
Study type: Interventional
Phase: Phase 4

Summary: 
      The objective of this prospective study is to determine the incidence of mycoplasma in women
      with overactive bladder (OAB) symptoms and whether antibiotic therapy targeting these
      organisms is effective.
    

Detailed description: 
      Overactive bladder (OAB) syndrome is described as 'urgency, with or without urge
      incontinence, usually with frequency and nocturia' by the 2002 ICS Terminology Committee. A
      variety of medical conditions share the symptoms of OAB, and it is important to exclude these
      in the process of diagnosis. Urinary tract infection (UTI) is the most frequent alternative
      diagnosis. Even in patients considered to have interstitial cystitis, OAB is a high
      probability of diagnosis due to its insidious onset of irritative symptoms.For these reasons,
      ICS Terminology Committee stated that the term OAB can be used only if there is no proven
      infection or other obvious pathology.

      Isolating causative organisms through urine culture plays a crucial role, but is likely to
      reveal a positive result in less than half of patients presenting with irritative symptoms.
      Even though ordinary bacteria are not cultured from these patients, there is some evidence to
      suggest that atypical organisms, such as genital mycoplasma, may be associated with OAB
      symptoms. For example, 48% of patients with chronic voiding symptoms showed positive cultures
      for Ureaplasma urealyticum and Mycoplasma hominis. In 91% of the patients with positive
      culture, symptom severity and frequency were improved after treatment. Another evidence for
      mycoplasmal involvement in OAB symptoms derives from the improvements in symptoms in more
      than two-thirds of patients complaining of persistent frequency and urgency after the use of
      doxycyline which is effective against U. urealyticum, M. hominis and Chlamydia trachomatis.

      Mycoplasmas are the simplest micro-organisms regarded as true bacteria. They are highly
      pleomorphic parasites of humans and the absence of a cell wall has been used to distinguish
      mycoplasma and to place them taxonomically in the class Mollicutes.Mycoplasmas are not
      generally viewed as being highly virulent, although they usually manifest a predilection for
      particular host tissues, such as the urogenital or respiratory tracts. It is now being
      recognized that these organisms play a more important role in human infections than was
      previously thought. Its slow-growing, non-culturable nature enables them to establish chronic
      infections, resist the effects of antibiotics and protect the organisms against immune system
      reactivity.Accordingly, for patients presenting with irritative bladder symptoms, and
      especially whose first culture is negative, a further culture may be indicated to test
      specifically for Mycoplasma or Chlamydia infection.
    

Intervention name(s): azithromycin, doxycycline
Intervention type(s): Drug
Intervention description(s): azithromycin 1g once for women with positive cultures at baseline
doxycycline 100 mg twice daily for 7 days for women with persistent infection after treatment of azithromycin 1g
Other intervention name(s): azithromycin; doxycycline
Intervention MeSH terms: Azithromycin; Doxycycline
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Overactive bladder; Mycoplasma