From the Guidelines
Nitrofurantoin is a first-line therapy for uncomplicated cystitis, with a recommended regimen of nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for 5 days. Alternatively, trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg twice daily for 3 days can be used in areas where local resistance rates are less than 20% 1. Fosfomycin 3 grams as a single dose is another first-line option 1. Before starting treatment, it's essential to confirm symptoms of uncomplicated cystitis, which include dysuria, frequency, urgency, and suprapubic pain, without fever or flank pain. Patients should complete the full course of antibiotics even if symptoms improve quickly. Adequate hydration is also recommended during treatment. These antibiotics are preferred as first-line agents because they achieve high concentrations in the urinary tract, have good efficacy against common uropathogens like E. coli, and have less impact on intestinal flora compared to fluoroquinolones, which are now reserved for situations where other options cannot be used due to resistance concerns 1.
Some key points to consider when choosing a first-line therapy for uncomplicated cystitis include:
- Local resistance rates: TMP-SMX should only be used in areas where local resistance rates are less than 20% 1.
- Patient factors: Fosfomycin may be a good option for patients who prefer a single-dose regimen or have difficulty adhering to a longer course of treatment 1.
- Side effects: Nitrofurantoin and TMP-SMX have similar side effect profiles, while fosfomycin has a lower risk of side effects 1.
- Efficacy: All three first-line options have high efficacy rates against common uropathogens like E. coli 1.
Overall, the choice of first-line therapy for uncomplicated cystitis should be based on individual patient factors, local resistance rates, and the potential risks and benefits of each antibiotic option 1.
From the FDA Drug Label
Adult Patients: 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.
First-line therapy for uncomplicated cystitis is ciprofloxacin (PO) 2, as it is indicated for the treatment of acute uncomplicated cystitis in females caused by Escherichia coli or Staphylococcus saprophyticus.
- Key points:
- Ciprofloxacin is effective against Escherichia coli and Staphylococcus saprophyticus, common causes of uncomplicated cystitis.
- It is a recommended treatment option for acute uncomplicated cystitis in females.
From the Research
First-Line Therapies for Uncomplicated Cystitis
- Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days) is a first-line therapy for uncomplicated cystitis 3
- Nitrofurantoin monohydrate/macrocrystals (100 mg twice daily for 5-7 days) is also a first-line therapy for uncomplicated cystitis 3, 4, 5, 6
- Fosfomycin trometamol (3 g in a single dose) is another first-line therapy for uncomplicated cystitis 3, 5, 6
- Pivmecillinam is also recommended as a first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 5
Considerations for Antibiotic Choice
- The choice of antibiotic should be based on individualized assessment of risk factors for resistance and regimen tolerability 3
- Fluoroquinolones should be reserved for more invasive infections due to the risk of resistance development 3, 6
- β-Lactam agents (amoxicillin-clavulanate and cefpodoxime-proxetil) are not as effective as empirical first-line therapies 3