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Cystitis medical therapy
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Empiric Therapy for Acute Cystitis
Acute Bacterial Uncomplicated Cystitis
Preferred Regimen
▸
Nitrofurantoin
100 mg PO q12h × 5 days
OR
▸
TMP
100 mg PO q12h ×3 days
OR
▸
Fosfomycin
3 gm PO single dose
OR
If resistence<20% or if used for UTI >3 months
▸
TMP-SMX
‡ 1 DS tab PO q12h × 3 days
OR
Not FDA approved but used in some European countries
▸
Pivmecillinam
400 mg PO q12h 3-7 days
Alternative Regimen
▸
Fluoroquinolones
for 3 days
▸
Ofloxacin
200–400 mg PO bid
OR
▸
Ciprofloxacin
250 mg bid PO or Cipro XR 500 mg q24h
OR
▸
Levofloxacin
250–750 mg PO q24
OR
▸
β-lactam
agents for 3-7 days
▸
Amoxicillin-clavulanate
500/125 mg PO q8h or 875/125 mg PO q8h
OR
▸
Cefdinir
300 mg PO q12h or 600 mg PO q24
OR
Cefaclor
250-500 mg PO q8h
OR
▸
Cefpodoxime proxetil
100-200 mg PO q12h
OR
Cephalexin
250-500 mg PO q6h
not studied well but effective
.
Complicated/Catheter Associated Cystitis
Preferred Regimen
Mild Infection
▸
Levofloxacin
750 mg PO q24 × 5 days
Delayed Response
▸
Levofloxacin
750 mg PO q24 × 10-14 days
After Catheter Removal
▸
Levofloxacin
750 mg PO q24 × 3 days
Acute Cystitis in Pregnancy
Preferred Regimen
▸
Nitrofurantoin
100 mg PO q12h × 3-5 days
OR
▸
Fosfomycin
3 g PO single dose
OR
▸
Amoxicillin-clavulanate
500/125 mg PO q12h × 3-5 days
OR
▸
Amoxicillin
500 mg PO q12h × 3-5 days
OR
▸
Cephalexin
500 mg PO q12h × 3-5 days
OR
▸
TMP-SMX
DS 1 tab PO q12h × 3-5 days
avoid in first trimester(
TMP
) and third trimester (
SMX
).
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