What is the best treatment for a 41-year-old female with cystitis (urinary tract infection)?

From the Guidelines

For a 41-year-old female with cystitis, the recommended first-line treatment is nitrofurantoin 100 mg taken orally twice daily for 5 days or trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg (one double-strength tablet) twice daily for 3 days, as supported by the most recent and highest quality study 1.

Treatment Options

• Nitrofurantoin 100 mg taken orally twice daily for 5 days
• Trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg (one double-strength tablet) twice daily for 3 days
• Fosfomycin 3 grams as a single oral dose can be effective, as noted in 1

Additional Recommendations

• Increase fluid intake to help flush bacteria from the urinary tract
• Take phenazopyridine 200 mg three times daily for 2 days to relieve painful urination symptoms
• If symptoms don't improve within 48-72 hours or worsen at any point, seek medical attention as a different antibiotic may be needed based on urine culture results

Preventive Measures

• Urinate after sexual intercourse
• Wipe from front to back after using the toilet
• Stay well-hydrated
• Avoid irritants like bubble baths or feminine hygiene sprays These antibiotics work by inhibiting bacterial growth or killing bacteria in the urinary tract, and the choice of treatment should be guided by the most recent and highest quality evidence, such as the study published in 1. Recurrent infections (3 or more per year) may require prophylactic antibiotics or further evaluation.

From the FDA Drug Label

Fosfomycin tromethamine granules for oral solution is indicated only for the treatment of uncomplicated urinary tract infections (acute cystitis) in women due to susceptible strains of Escherichia coli and Enterococcus faecalis. The best treatment for a 41-year-old female with cystitis is fosfomycin (PO), as it is indicated for the treatment of uncomplicated urinary tract infections (acute cystitis) in women due to susceptible strains of Escherichia coli and Enterococcus faecalis 2.

• The recommended dosage is one sachet of fosfomycin tromethamine granules for oral solution 2.

From the Research

Treatment Options for Acute Uncomplicated Cystitis

• First-line treatment options for acute uncomplicated cystitis include:
  • Fosfomycin 3, 4, 5, 6
  • Nitrofurantoin 3, 4, 5
  • Trimethoprim/sulfamethoxazole (in regions where the prevalence of Escherichia coli resistance does not exceed 20 percent) 3
  • Pivmecillinam 4
• Second-line options include:
  • Oral cephalosporins such as cephalexin or cefixime 4
  • Fluoroquinolones 4
  • β-lactams, such as amoxicillin-clavulanate 4
• Treatment options for UTIs due to ESBLs-E coli include:
  • Nitrofurantoin 4
  • Fosfomycin 4
  • Pivmecillinam 4
  • Amoxicillin-clavulanate 4
  • Finafloxacin 4
  • Sitafloxacin 4

Diagnosis and Management

• Acute uncomplicated cystitis can be diagnosed without an office visit or urine culture 5
• A urinalysis, but not urine culture, is recommended in making the diagnosis 3
• Immediate antimicrobial therapy is recommended rather than delayed treatment or symptom management with ibuprofen alone 5

Specific Patient Populations

• Women with diabetes without voiding abnormalities presenting with acute cystitis should be treated similarly to women without diabetes 5
• Individualized assessment of risk factors for resistance and regimen tolerability is needed to choose the optimum empirical regimen 5