Ascorbic acid (for acidification of urine) has not been included as the BNF classifies it as "less suitable for prescribing". The high doses that are required can lead to renal stones in those with hyperoxaluria.

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is mild cystitis.

Many products for mild cystitis e.g. potassium citrate mixtures are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Potassium citrate mixture BP

• Oral solution (£3.31 = 200ml)

Indications

• Relief of discomfort in mild urinary-tract infections; alkalinisation of urine

Dose

• 10ml three times daily, well diluted with water

Notes

1. The discomfort of cystitis may be relieved by alkalinisation of urine with potassium citrate.

Pentosan polysulfate sodium

• Capsules 100mg

Notes

1. NICE TA610: Pentosan polysulfate sodium (Elmiron) is recommended as an option for treating bladder pain syndrome with glomerulations or Hunner's lesions in adults with urinary urgency and frequency, and moderate to severe pain, only when the criteria of the NICE TA are met (November 2019).
2. MHRA Drug Safety Update (September 2019): Cases of pigmentary maculopathy leading to visual impairment have been reported with pentosan polysulfate, particularly after long-term use at high doses. Ensure patients taking pentosan polysulfate have regular ophthalmic examinations and ask them to promptly seek medical advice in case of visual changes.