Uncomplicated Cystitis

Clinical Features And DiagnosisTop

Typical clinical features of uncomplicated cystitis include dysuria, frequency, and suprapubic pain, sometimes also urgency/incontinence and hematuria (in ~40% of patients), as well as suprapubic tenderness. Additionally, leukocyturia and bacteriuria >105 colony-forming units (CFU)/mL (in some patients 102-104 CFU/mL) are seen. Untreated uncomplicated cystitis may last from a few to >10 days. In the absence of clinical uncertainty, the benefit of urinalysis and urine cultures is minimal in uncomplicated cystitis and therefore testing is not required.

TreatmentTop

1. First-line agents:

1) Oral nitrofurantoin 100 mg bid for 5 days (preferred agent due to low resistance rates and similar efficacy as trimethoprim/sulfamethoxazole).Evidence 1Strong recommendation (downsides clearly outweigh benefits; right action for all or almost all patients). High Quality of Evidence (high confidence that we know true effects of the intervention). Gupta K, Hooton TM, Roberts PL, Stamm WE. Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women. Arch Intern Med. 2007 Nov 12;167(20):2207-12. PMID: 17998493.

2) Other options include fosfomycin 3 g in a single dose (in particular if a strain producing extended-spectrum beta-lactamase [ESBL] is suspected), pivmecillinam 400 mg tid for 3 days, oral cephalosporins (eg, cephalexin 500 mg qid or cefadroxil 500 mg bid for 3 days), or trimethoprim/sulfamethoxazole 160/800 mg bid for 3 days. If the listed antibiotics are not available or not appropriate because of resistance or contraindications in a particular situation or geographic region, other choices may be guided by local circumstances, including induction of resistance in population.

3) Fluoroquinolones that have historically been used as first-line antibiotics should be avoided unless no other options are available.

2. Ibuprofen is inferior to antibiotic treatment, but two-thirds of women with uncomplicated cystitis recover without antibiotics. Therefore, ibuprofen can be considered if patients would prefer to avoid exposure to antibiotics.

3. Follow-up: In female patients with no symptoms persisting after treatment, no follow-up urine testing is indicated.