Cystitis medical therapy: Difference between revisions
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Revision as of 15:02, 12 June 2013
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Steven C. Campbell, M.D., Ph.D.
Overview
Because of the risk of the infection spreading to the kidneys (complicated UTI) and due to the high complication rate in the elderly population and in diabetics, prompt treatment is almost always recommended.
Medical Therapy
Antibiotics are used to control bacterial infection. It is vital that one finish an entire course of prescribed antibiotics. Commonly used antibiotics include:
- Nitrofurantoin
- Trimethoprim-sulfamethoxazole
- Amoxicillin
- Cephalosporins
- Ciprofloxacin or levofloxacin
The choice of antibiotic should preferably be guided by the result of urine culture. Chronic or recurrent UTI should be treated thoroughly because of the chance of kidney infection (pyelonephritis). Antibiotics control the bacterial infection. They may be required for long periods of time. Prophylactic low-dose antibiotics are sometimes recommended after acute symptoms have subsided. Pyridium may be used to reduce the burning and urgency associated with cystitis. In addition, common substances that increase acid in the urine, such as ascorbic acid or cranberry juice, may be recommended to decrease the concentration of bacteria in the urine. Follow-up may include urine cultures to ensure that bacteria are no longer present in the bladder.
- Shown below is a table summarizing the preferred and alternative empiric treatment for cystitis.[1]
| Characteristics of the Patient | Possible Pathogens | Preferred Treatment | Duration of Treatment | Alternative Treatment |
| Acute uncomplicated cystitis (1) | Bacterial | Nitrofurantoin(Macrobid) 100 mg PO Q12H
OR TMP/SMX 1 DS tab PO Q12H (2) OR Fosfomycin 3 gm single dose (3) OR Pivmecillinam 400 mg bid (3) |
Nitrofurantoin for 5 days
OR TMP/SMX for 3 days OR Fosfomycin single dose OR Pivmecillinam for 5 days |
The fluoroquinolones, ofloxacin, ciprofloxacin, and 'levofloxacin, in 3-day regimens are highly efficacious.
OR β-lactam agents including amoxicillin-clavulanate, cefdinir, cefaclor, and cefpodoxime-proxetil in 3- to 7-day regimens OR Other β-lactams, such as cephalexin, are less well studied but may also be appropriate in certain settings. |
| Symtomatic cystitis in the non-neutropenic patient | Candida | Fluconazole 200 mg IV/PO once daily | Fluconazole for 7 - 14 days | Fluconazole - resistant organism suspected or confirmed
Amphotericin B 0.3 - 0.6 mg/kg IV once daily for 1 - 7 days |
(1) Acute uncomplicated cystitis: Premenopausal, nonpregnant women with no known urological abnormalities or comorbidities,postmenopausal women or well-controlled diabetes female patient
(2) Avoid if resistance prevalence is known to exceed 20% or if used for UTI in previous 3 months
(3) Lower efficacy than some other recommended agents; avoid if pyelonephritis suspected
References
- ↑ Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG; et al. (2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clin Infect Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMID 21292654.