From the Guidelines
The first-line antibiotic treatment for uncomplicated cystitis in Australia is Fosfomycin trometamol 3g taken as a single dose, as recommended by the European Association of Urology guidelines 1. This recommendation is based on the most recent and highest quality study available, which suggests that Fosfomycin trometamol is a suitable first-line treatment option for uncomplicated cystitis in women 1. The guidelines also suggest alternative treatment options, including Nitrofurantoin macrocrystals 50-100mg taken four times daily for 5 days, or Nitrofurantoin monohydrate or macrocrystals 100mg taken twice daily for 5 days 1. It's essential to note that the choice of antibiotic should be based on local bacterial resistance patterns and patient-specific factors, such as allergy history and renal function. Before starting antibiotics, it's crucial to collect a urine sample for culture, though treatment can begin before results are available 1, 1. Patients should be advised to maintain adequate hydration and can use over-the-counter pain relievers like paracetamol or ibuprofen for symptom relief. Symptoms should improve within 2-3 days of starting treatment, and patients should seek further medical advice if symptoms persist or worsen. Key considerations in the management of uncomplicated cystitis include:
- Using the most recent and highest quality evidence to guide treatment decisions 1
- Considering local bacterial resistance patterns and patient-specific factors when choosing an antibiotic 1, 1
- Collecting a urine sample for culture before starting treatment 1, 1
- Advising patients to maintain adequate hydration and use over-the-counter pain relievers as needed 1, 1
From the Research
First-Line Antibiotic Treatment for Uncomplicated Cystitis in Australia
- 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 2.
- High rates of resistance for trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients who were recently exposed to them or in patients who are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales 2.
- Alternative first-line therapies for uncomplicated cystitis include trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days), nitrofurantoin monohydrate/macrocrystals (100 mg twice daily for 5-7 days), and fosfomycin trometamol (3 g in a single dose) 3.
- Fluoroquinolones are effective for clinical outcomes but should be reserved for more invasive infections 3.
- β-Lactam agents (amoxicillin-clavulanate and cefpodoxime-proxetil) are not as effective as empirical first-line therapies 3.
Considerations for Antibiotic Resistance
- Increasing resistance rates among uropathogens have complicated treatment of acute cystitis 2, 3.
- Individualized assessment of risk factors for resistance and regimen tolerability is needed to choose the optimum empirical regimen 3.
- The use of new antimicrobials should be done wisely to avoid resistance development 2.