Uncomplicated Bacterial Cystitis

Uncomplicated bacterial cystitis is characterized by dysuria, frequency, urgency, suprapubic pain and pyuria, in the absence of fever. Elevated temperature points to pyelonephritis or complicated infection. If there are no risk factors for a complicated infection (see above), it is sufficient for the diagnosis, to establish the presence of nitrate and/or leukocyte esterase with a rapid dipstick method as summarized in Fig 1. If positive, a culture is not necessary and the patient should be treated with a 3-days course of antibiotics. Key to the successful treatment is the impregnation ofthe urinary tract with antibiotics during > 72 hours. Many treatments have been evaluated. It has been clearly demonstrated, that cotrimoxazole or fluoroquinolones are more efficient than betalactam antibiotics45. The following 3-days regimens are frequently used: trimethoprim 300 mg q24h, cotrimoxazol 960 mg q12h, norfloxacin 400 mg q12h, ciprofloxacin 250 mg q12h, or fosfomycine 3g (as a single dose). General measures include drinking to increase the urinary output. Once the treatment is completed, the urine sediment should be normal and the urine culture negative after 10-14 days.

Figure 1 Approach ofuncomplicated bacterial cystitis.
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