From the Guidelines
Female cystitis typically presents with symptoms including dysuria, frequency, urgency, and sometimes hematuria, with diagnosis often made based on a focused history of lower urinary tract symptoms and absence of vaginal discharge 1. The symptoms of female cystitis can vary, but common signs and symptoms include:
- Dysuria (painful urination)
- Frequency (frequent urination)
- Urgency (sudden, intense need to urinate)
- Hematuria (blood in the urine)
- Cloudy or strong-smelling urine
- Pelvic pressure
- Low-grade fever These symptoms occur when bacteria, most commonly Escherichia coli, enter and infect the bladder 1. According to the European Association of Urology guidelines, diagnosis of uncomplicated cystitis can be made with a high probability based on a focused history of lower urinary tract symptoms and the absence of vaginal discharge, with urine analysis leading to only a minimal increase in diagnostic accuracy 1. It's worth noting that in elderly women, genitourinary symptoms are not necessarily related to cystitis, and a urine culture is recommended in certain situations, such as suspected acute pyelonephritis or symptoms that do not resolve or recur within 4 weeks after completion of treatment 1. In patients presenting with typical symptoms of uncomplicated cystitis, symptomatic therapy, such as ibuprofen, may be considered as an alternative to antimicrobial treatment in consultation with individual patients 1.
From the Research
Signs and Symptoms of Female Cystitis
- The provided studies do not directly address the signs and symptoms of female cystitis, but rather focus on the treatment and management of the condition 2, 3, 4, 5, 6.
Treatment of Female Cystitis
- The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 3.
- A 5-day course of nitrofurantoin is equivalent clinically and microbiologically to a 3-day course of trimethoprim-sulfamethoxazole and should be considered an effective fluoroquinolone-sparing alternative for the treatment of acute cystitis in women 4.
- Renal function should be considered in the clinical decision-making for cystitis treatment, as it can affect the effectiveness of different antibiotics 5.
- Physicians often prescribe antibiotics for longer durations than recommended, which can contribute to antibiotic resistance 2, 6.
Antibiotic Resistance and Treatment Duration
- High rates of resistance to trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities 3.
- The duration of most prescriptions for TMP-SMX, nitrofurantoin, and FQs is longer than guidelines recommendations 2.
- Older age and presence of diabetes are independently associated with longer treatment duration 2.