Cystitis medical therapy

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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.

Shown below is a table summarizing the preferred and alternative empiric treatment for meningitis.

Characteristics of the Patient	Possible Pathogens	Preferred Treatment	Duration of Treatment
Symtomatic uncomplicated cystitis (1)	Bacterial	Cephalexin 500 mg PO Q6H OR Cefpodoxime 100 mg PO Q12H OR Nitrofurantoin(Macrobid) 100 mg PO Q12H (DO NOT USE IN PATIENT WITH CrCL <50ml/min) OR TMP/SMX 1 DS tab PO Q12H	Cephalexin for 7 days OR Cefpodoxime for 7 days OR Nitrofurantoin for 5 days OR TMP/SMX for 3 days