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LETTER |
The authors are with the Department of Public Health and Primary Health Care, Division for General Practice, University of Bergen, Norway.
Correspondence: Requests for reprints should be sent to Terje Alraek, BAc, University of Bergen, Department of Public Health and Primary Health Care, Division for General Practice, Ulriksdal 8c, N-5009 Bergen, Norway (e-mail: terje.alrek{at}isf.uib.no).
Katz raises important issues, which need to be considered in further studies on acupuncture and recurrent cystitis. Our answers will, hopefully, further elucidate some of these points.
The subjects in our study were asked to seek medical aid in case of acute symptoms of cystitis. If a doctor was not available, patients were instructed to culture a preaddressed dip-slide and mail it to the laboratory for bacteriological examination. Having provided urine for culture, the patients could start medical treatment or not, according to preference. Norwegian doctors normally prescribe a 3- to 5-day course of antibiotics for acute cystitis. None of the patients were put on more prolonged courses or continuous antibiotic prophylaxis during the study. Nor were they allowed to use cranberries for prophylaxis. We have no information on type of antibiotic used, as this decision was the responsibility of each patient’s family doctor. To our knowledge differences in treatment strategies for acute, uncomplicated cystitis in otherwise healthy women do not correlate to their further prognosis with regard to cystitis.
We agree with Katz that further studies in complementary and alternative medicine should focus on biological plausibility of the findings as a key issue. As far as we know, our study is the first acupuncture study to focus on the relationship between recurrent cystitis and residual urine. These findings are in general relevant for understanding the pathogenesis of recurrent cystitis.
In our most recent study,1 we also performed urodynamic studies and measurement of the vagal and adrenergic tone. However, these parameters did not indicate further explanations regarding the treatment effect.
The American Food and Drug Administration has recommended acupuncture (stimulation of the P6 acupuncture point) as an antiemetic treatment. This recommendation is partly due to systematic reviews and meta-analysis concluding clinically significant results,2,3 but still the actual explanation for the effect is lacking.
To clarify, residual urine was not incorporated as a parameter in our earlier study.4
Patients who became pregnant in our study were taken out of the study at the time the pregnancy was diagnosed. Cystitis occurring in pregnant women is by definition no longer uncomplicated5 and should of course be treated accordingly.
At this stage it is too early for final conclusions, but we hope that other researchers can duplicate our results. This will add to evidence for the use of acupuncture as prophylactic treatment for recurrent cystitis in women of reproductive age.
References
1. Alraek T, Soedal LIF, Fagerheim SU, Digranes A, Baerheim A. Acupuncture treatment in the prevention of uncomplicated recurrent lower urinary tract infections in adult women. Am J Public Health.2002;92:1609–1611.
2. Vickers AJ. Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med.1996;89:303–311.[Abstract]
3. Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Anesth Analg.1999;88:1362–1369.
4. Aune A, Alraek T, LiHua H, Baerheim A. Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scand J Prim Health Care.1998;16:37–39.[Medline]
5. van Haarst EP, van Andel G, Heldeweg EA, Schlatmann TJ, van der Horst HJ. Evaluation of the diagnostic workup in young women referred for recurrent lower urinary tract infections. Urology.2001;57:1068–1072.[Medline]
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