From the Guidelines
Urinary tract infections (UTIs) and cystitis are related but distinct conditions, with UTI being a broader term that encompasses infections in any part of the urinary system, including cystitis, which specifically refers to inflammation of the bladder. The key difference between the two lies in the location and severity of the infection. Cystitis is a type of UTI that affects the bladder, whereas UTIs can also involve the urethra (urethritis), kidneys (pyelonephritis), or ureters 1. Some of the most common symptoms of both conditions include:
- Painful urination
- Frequent urination
- Urgency
- Cloudy urine
- Lower abdominal discomfort However, kidney infections may additionally cause fever, flank pain, and nausea. Treatment for uncomplicated cystitis should involve short-course antibiotics, such as nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days, or fosfomycin as a single dose, as recommended by the American College of Physicians 1. In contrast, more severe UTIs affecting the kidneys may require longer courses (7-14 days) of fluoroquinolones like ciprofloxacin or broader-spectrum antibiotics. The distinction between UTI and cystitis matters because upper urinary tract infections (involving kidneys) generally require more aggressive treatment than lower tract infections (bladder and urethra) 1. Both conditions are more common in women due to their shorter urethra, which allows bacteria easier access to the bladder. Preventive measures, such as staying hydrated, urinating after sexual activity, and proper hygiene, can help prevent recurrence of both conditions. It is essential to note that the treatment approach may vary depending on the severity and location of the infection, as well as the patient's overall health status and antibiotic susceptibility 1.
From the FDA Drug Label
Urinary Tract Infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii, Citrobacter diversus, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus epidermidis, Staphylococcus saprophyticus, or Enterococcus faecalis Acute Uncomplicated Cystitis in females caused by Escherichia coli or Staphylococcus saprophyticus.
The main difference between UTI (Urinary Tract Infections) and cystitis is the location and severity of the infection.
- UTI refers to a broader range of infections that can occur in any part of the urinary tract, including the kidneys, ureters, bladder, and urethra.
- Cystitis is a specific type of UTI that affects the bladder. According to the drug label, ciprofloxacin is indicated for the treatment of both Urinary Tract Infections and Acute Uncomplicated Cystitis in females 2.
From the Research
UTI vs Cystitis: Definition and Diagnosis
- Urinary Tract Infection (UTI) and cystitis are two related but distinct conditions, with UTI referring to an infection in any part of the urinary system, and cystitis specifically referring to an infection of the bladder 3, 4.
- Cystitis is usually manifested by dysuria, frequency, and/or urgency without fever, while pyelonephritis (a type of UTI that affects the kidneys) is usually manifested by fever and back pain/costovertebral angle tenderness 4.
- The diagnosis of uncomplicated cystitis is usually easily made based on clinical presentation, whereas the diagnosis in patients with complicated UTI is often more complex 4.
Treatment of UTI and Cystitis
- Treatment of cystitis is usually straightforward with one of several effective short-course antimicrobial regimens, although antimicrobial resistance continues to increase and can complicate treatment choices in certain areas 3, 4.
- Recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females includes nitrofurantoin, fosfomycin tromethamine, or pivmecillinam 5.
- Fluoroquinolones are effective for clinical outcomes but should be reserved for more invasive infections, and β-Lactam agents (amoxicillin-clavulanate and cefpodoxime-proxetil) are not as effective as empirical first-line therapies 3, 5.
Antimicrobial Resistance and Treatment Options
- Increasing resistance rates among uropathogens have complicated treatment of acute cystitis, and individualized assessment of risk factors for resistance and regimen tolerability is needed to choose the optimum empirical regimen 3, 5.
- Treatment options for UTIs due to antibiotic-resistant Gram-negative bacteria include nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, and β-lactams, as well as parenteral treatment options such as piperacillin-tazobactam, carbapenems, and aminoglycosides 5.
- It is essential to use new antimicrobials wisely for treatment of UTIs caused by multidrug-resistant organisms to avoid resistance development 5, 6, 7.