Cystitis medical therapy: Difference between revisions
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'''Pivmecillinam''' 400 mg bid (3) | '''Pivmecillinam''' 400 mg bid (3) | ||
|'''Nitrofurantoin''' for 5 days | |'''Nitrofurantoin''' for 5 days | ||
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Other '''β-lactams''', such as '''cephalexin''', are less well studied but may also be appropriate in certain settings. | Other '''β-lactams''', such as '''cephalexin''', are less well studied but may also be appropriate in certain settings. | ||
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| Symtomatic cystitis in the non-neutropenic patient | | Symtomatic cystitis in the non-neutropenic patient | ||
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(2) Avoid if resistance prevalence is known to exceed 20% or if used for UTI in previous 3 months | (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 | (3) Lower efficacy than some other recommended agents; avoid if pyelonephritis suspected | ||
==References== | ==References== | ||
Revision as of 17:34, 28 November 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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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
- Doxycycline
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.
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
- Doxycycline
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.
| 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) Uncomplicated cystitis: Female, no urologic abnormalities, no stones, no catheter
(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