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*Being the most common cause of cystitis(75-90%), E.Coli susceptibility should be considered to choose the appropriate empirical antimicrobial.Other organisms like Proteus mirabilis, Klebsiella pneumoniae and Staphylococcus saprophyticus are far less common. | *Being the most common cause of cystitis(75-90%), E.Coli susceptibility should be considered to choose the appropriate empirical antimicrobial.Other organisms like Proteus mirabilis, Klebsiella pneumoniae and Staphylococcus saprophyticus are far less common. | ||
*[[Nitrofurantoin]], [[fosfomycin]] and mecillinam are prefered as first line treatment because have less resistance among other antibacterials | *[[Nitrofurantoin]], [[fosfomycin]] and mecillinam are prefered as first line treatment because have less resistance among other antibacterials <ref name="Kahlmeter-2003">{{Cite journal | last1 = Kahlmeter | first1 = G. | title = An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. | journal = J Antimicrob Chemother | volume = 51 | issue = 1 | pages = 69-76 | month = Jan | year = 2003 | doi = | PMID = 12493789 }}</ref><ref name="Naber-2008">{{Cite journal | last1 = Naber | first1 = KG. | last2 = Schito | first2 = G. | last3 = Botto | first3 = H. | last4 = Palou | first4 = J. | last5 = Mazzei | first5 = T. | title = Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. | journal = Eur Urol | volume = 54 | issue = 5 | pages = 1164-75 | month = Nov | year = 2008 | doi = 10.1016/j.eururo.2008.05.010 | PMID = 18511178 }}</ref>with similar efficacy.<ref name="Gupta-2007">{{Cite journal | last1 = Gupta | first1 = K. | last2 = Hooton | first2 = TM. | last3 = Roberts | first3 = PL. | last4 = Stamm | first4 = WE. | title = Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women. | journal = Arch Intern Med | volume = 167 | issue = 20 | pages = 2207-12 | month = Nov | year = 2007 | doi = 10.1001/archinte.167.20.2207 | PMID = 17998493 }}</ref><ref name="Iravani-1999">{{Cite journal | last1 = Iravani | first1 = A. | last2 = Klimberg | first2 = I. | last3 = Briefer | first3 = C. | last4 = Munera | first4 = C. | last5 = Kowalsky | first5 = SF. | last6 = Echols | first6 = RM. | title = A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection. | journal = J Antimicrob Chemother | volume = 43 Suppl A | issue = | pages = 67-75 | month = Mar | year = 1999 | doi = | PMID = 10225575 }}</ref><ref name="Stein-1999">{{Cite journal | last1 = Stein | first1 = GE. | title = Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection. | journal = Clin Ther | volume = 21 | issue = 11 | pages = 1864-72 | month = Nov | year = 1999 | doi = 10.1016/S0149-2918(00)86734-X | PMID = 10890258 }}</ref><ref name="Minassian-1998">{{Cite journal | last1 = Minassian | first1 = MA. | last2 = Lewis | first2 = DA. | last3 = Chattopadhyay | first3 = D. | last4 = Bovill | first4 = B. | last5 = Duckworth | first5 = GJ. | last6 = Williams | first6 = JD. | title = A comparison between single-dose fosfomycin trometamol (Monuril) and a 5-day course of trimethoprim in the treatment of uncomplicated lower urinary tract infection in women. | journal = Int J Antimicrob Agents | volume = 10 | issue = 1 | pages = 39-47 | month = Apr | year = 1998 | doi = | PMID = 9624542 }}</ref> | ||
*[[TMP-SMX]] is preferred to use in areas where the resistance rates are less than 20%.<ref name="Gupta-2003">{{Cite journal | last1 = Gupta | first1 = K. | title = Emerging antibiotic resistance in urinary tract pathogens. | journal = Infect Dis Clin North Am | volume = 17 | issue = 2 | pages = 243-59 | month = Jun | year = 2003 | doi = | PMID = 12848469 }}</ref><ref name="Raz-2002">{{Cite journal | last1 = Raz | first1 = R. | last2 = Chazan | first2 = B. | last3 = Kennes | first3 = Y. | last4 = Colodner | first4 = R. | last5 = Rottensterich | first5 = E. | last6 = Dan | first6 = M. | last7 = Lavi | first7 = I. | last8 = Stamm | first8 = W. | title = Empiric use of trimethoprim-sulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens. | journal = Clin Infect Dis | volume = 34 | issue = 9 | pages = 1165-9 | month = May | year = 2002 | doi = 10.1086/339812 | PMID = 11941541 }}</ref> | *[[TMP-SMX]] is preferred to use in areas where the resistance rates are less than 20%.<ref name="Gupta-2003">{{Cite journal | last1 = Gupta | first1 = K. | title = Emerging antibiotic resistance in urinary tract pathogens. | journal = Infect Dis Clin North Am | volume = 17 | issue = 2 | pages = 243-59 | month = Jun | year = 2003 | doi = | PMID = 12848469 }}</ref><ref name="Raz-2002">{{Cite journal | last1 = Raz | first1 = R. | last2 = Chazan | first2 = B. | last3 = Kennes | first3 = Y. | last4 = Colodner | first4 = R. | last5 = Rottensterich | first5 = E. | last6 = Dan | first6 = M. | last7 = Lavi | first7 = I. | last8 = Stamm | first8 = W. | title = Empiric use of trimethoprim-sulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens. | journal = Clin Infect Dis | volume = 34 | issue = 9 | pages = 1165-9 | month = May | year = 2002 | doi = 10.1086/339812 | PMID = 11941541 }}</ref> | ||
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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 decision to use antimicrobials should be case by case, in other word it should depend on the patients specifics like allergy and compliance history, availability and cost of treatment and resistant rates at the local community.
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]
|
† 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.
- Being the most common cause of cystitis(75-90%), E.Coli susceptibility should be considered to choose the appropriate empirical antimicrobial.Other organisms like Proteus mirabilis, Klebsiella pneumoniae and Staphylococcus saprophyticus are far less common.
- Nitrofurantoin, fosfomycin and mecillinam are prefered as first line treatment because have less resistance among other antibacterials [2][3]with similar efficacy.[4][5][6][7]
- Nitrofurantoin, fosfomycin and mecillinam shouldn't be used when pyelonephritis is suspected, because they have weak penetration to the renal tissue.
- Use of broad-spectrum antimicrobials resulted multi-drug resistant organisms, so they are used as alternative to the first line drugs in case of allergy, unavailability or intolerance.[10][11]
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.
- ↑ Kahlmeter, G. (2003). "An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project". J Antimicrob Chemother. 51 (1): 69–76. PMID 12493789. Unknown parameter
|month=ignored (help) - ↑ Naber, KG.; Schito, G.; Botto, H.; Palou, J.; Mazzei, T. (2008). "Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy". Eur Urol. 54 (5): 1164–75. doi:10.1016/j.eururo.2008.05.010. PMID 18511178. Unknown parameter
|month=ignored (help) - ↑ Gupta, K.; Hooton, TM.; Roberts, PL.; Stamm, WE. (2007). "Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women". Arch Intern Med. 167 (20): 2207–12. doi:10.1001/archinte.167.20.2207. PMID 17998493. Unknown parameter
|month=ignored (help) - ↑ Iravani, A.; Klimberg, I.; Briefer, C.; Munera, C.; Kowalsky, SF.; Echols, RM. (1999). "A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection". J Antimicrob Chemother. 43 Suppl A: 67–75. PMID 10225575. Unknown parameter
|month=ignored (help) - ↑ Stein, GE. (1999). "Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection". Clin Ther. 21 (11): 1864–72. doi:10.1016/S0149-2918(00)86734-X. PMID 10890258. Unknown parameter
|month=ignored (help) - ↑ Minassian, MA.; Lewis, DA.; Chattopadhyay, D.; Bovill, B.; Duckworth, GJ.; Williams, JD. (1998). "A comparison between single-dose fosfomycin trometamol (Monuril) and a 5-day course of trimethoprim in the treatment of uncomplicated lower urinary tract infection in women". Int J Antimicrob Agents. 10 (1): 39–47. PMID 9624542. Unknown parameter
|month=ignored (help) - ↑ Gupta, K. (2003). "Emerging antibiotic resistance in urinary tract pathogens". Infect Dis Clin North Am. 17 (2): 243–59. PMID 12848469. Unknown parameter
|month=ignored (help) - ↑ Raz, R.; Chazan, B.; Kennes, Y.; Colodner, R.; Rottensterich, E.; Dan, M.; Lavi, I.; Stamm, W. (2002). "Empiric use of trimethoprim-sulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens". Clin Infect Dis. 34 (9): 1165–9. doi:10.1086/339812. PMID 11941541. Unknown parameter
|month=ignored (help) - ↑ Paterson, DL. (2004). "Collateral damage from cephalosporin or quinolone antibiotic therapy". Clin Infect Dis. 38 Suppl 4: S341–5. doi:10.1086/382690. PMID 15127367. Unknown parameter
|month=ignored (help) - ↑ Ramphal, R.; Ambrose, PG. (2006). "Extended-spectrum beta-lactamases and clinical outcomes: current data". Clin Infect Dis. 42 Suppl 4: S164–72. doi:10.1086/500663. PMID 16544267. Unknown parameter
|month=ignored (help)