Symptomatic Treatment of MS - European Multiple Sclerosis Platform

pressin should only be given to patients with normal heart and kidney function. Dose should not exceed
20 µg intranasally [Eckford 1995], then treatment is mostly free of side effects [Tubridy 1999]. In a recent
meta-analysis a moderate effect of desmopressin on nocturia in people with MS could be demonstrated;
the number of voids during the night, and the urine volume within 6h after intake were reduced [Bosma
2005].
Treatment of acute bladder infection:
In patients with NBD bladder infections are common and should be treated with targeted antibiotics
[Naber 2001] for at least 10 days. Differentiation of bacteriuria versus unequivocal infection sometimes
may be difficult because of coexisting sensory disturbances or urge incontinence. Laboratory findings
including leucocyturia, elevated white blood cells as well as erythrocyte sedimentation rate and C-reactive
protein may help to make the diagnosis. Due to the shorter resting time of urine within the bladder,
the nitrite test may be falsely negative even when nitrite secreting bacteria are present.
Prophylaxis of recurrent bladder infection:
Low intravesical pressure and low residual volume should be achieved in order to reduce the frequency
of urinary tract infection [Sauerwein 2002]. For prophylaxis of infection, methenamine (2x1 g/d [Banovac
1991]) and methionine (3x500 mg/d [Fünfstück 1997]) can be used whereas the efficacy of cranberry
juice is questionable. The most important risk factor for complicated bladder infections is a transurethral
or suprapubic catheter. In these patients methenamine is not helpful because of its mechanism of action.
Even in acidic urine (pH