Cystitis medical therapy: Difference between revisions
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;Shown below is a table summarizing the preferred and alternative empiric treatment for cystitis.<ref name="pmid21292654">{{cite journal| author=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al.| title=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. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 5 | pages= e103-20 | pmid=21292654 | doi=10.1093/cid/ciq257 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292654 }} </ref> | ;Shown below is a table summarizing the preferred and alternative empiric treatment for cystitis.<ref name="pmid21292654">{{cite journal| author=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al.| title=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. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 5 | pages= e103-20 | pmid=21292654 | doi=10.1093/cid/ciq257 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292654 }} </ref> | ||
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| | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B| Acute Bacterial Uncomplicated Cystitis†}}'' | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nitrofurantoin]] 100 mg po q12h×5 days'''''<br>OR<br>▸ '''''[[TMP-SMX]]‡ 1 DS tab po q12h×3 days'''''<br>OR<br>'''''▸[[Fosfomycin]] 3 gm single dose'''''<br>OR<br> ▸'''''[[Pivmecillinam]]♦ 400 mg bid×5 days ''''' | |||
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|''' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
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'''OR'' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluoroquinolones]] for 3 days <br>[[Ofloxacin]] 200–400 mg po bid.<br>[[Ciprofloxacin]] 250 mg bid po or Cipro XR 500 mg q24h<br>[[Levofloxacin]] 250–750 mg po q24'''''<br>OR<br>'''''▸[[β-lactam]] agents for 3-7 days<br>[[Amoxicillin-clavulanate]] 500/125 mg po tid or 875/125 mg po bid <br>[[Cefdinir]] 300 mg po q12h or 600 mg po q24 <br>[[Cefaclor]] 250-500 mg po q8h<br>[[Cefpodoxime-proxetil]] 100-200 mg po q12h'''''<br>'''''Others([[Cephalexin]]250-500 mg po q6h ) not studied well but effective.''''' | ||
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'''TMP | |} | ||
'''OR'' | |||
'''Fosfomycin | |||
'''OR'' | |||
'''Pivmecillinam | |||
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'''OR'' | |||
'''β-lactam agents | |||
''' | |||
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† Acute uncomplicated cystitis: Premenopausal, nonpregnant women with no known urological abnormalities or comorbidities,postmenopausal women or well-controlled diabetes female patient. | |||
‡Avoid if resistance prevalence is known to exceed 20% or if used for UTI in previous 3 months. | |||
♦Pivmecillinam is available in some European countries, not licensed in US. | |||
==References== | ==References== | ||
Revision as of 14:34, 17 January 2014
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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]
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† Acute uncomplicated cystitis: Premenopausal, nonpregnant women with no known urological abnormalities or comorbidities,postmenopausal women or well-controlled diabetes female patient.
‡Avoid if resistance prevalence is known to exceed 20% or if used for UTI in previous 3 months.
♦Pivmecillinam is available in some European countries, not licensed in US.
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.