Doxycycline is Not Recommended for Uncomplicated Cystitis

Doxycycline is not recommended as a treatment option for uncomplicated cystitis according to current guidelines. 1, 2

First-Line Treatment Options for Uncomplicated Cystitis

The European Association of Urology and other clinical guidelines recommend the following first-line treatments:

Nitrofurantoin (100 mg twice daily for 5 days) - highly effective with minimal resistance and limited collateral damage 1, 2
Fosfomycin trometamol (3 g single dose) - appropriate first-line option, though may have slightly inferior efficacy compared to other regimens 1, 2
Pivmecillinam (400 mg three times daily for 3-5 days) - recommended where available 1

When first-line agents cannot be used, the following alternatives may be considered:

Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days) - appropriate only when local resistance rates are known to be <20% 1, 2
Cephalosporins (e.g., cefadroxil 500 mg twice daily for 3 days) - can be used if local E. coli resistance is <20% 1
Fluoroquinolones - should be reserved as alternative agents due to their propensity for promoting resistance and should be preserved for more serious infections 2

Doxycycline is not listed in any of the current guidelines as a recommended treatment option for uncomplicated cystitis 1, 2
The most common causative organism for uncomplicated cystitis is Escherichia coli 1, and the recommended antibiotics are selected based on their efficacy against this pathogen
Guidelines emphasize using antibiotics with minimal resistance patterns and limited collateral damage 2

Longer treatment duration (7 days) is recommended 1
Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 7 days) is recommended, or fluoroquinolones based on local susceptibility testing 1

For patients with sulfa and penicillin allergies, nitrofurantoin or fosfomycin are appropriate options 3, 2
In patients with CKD, nitrofurantoin should be avoided when eGFR is <30 ml/min 3

Diagnosis can be made with high probability based on symptoms (dysuria, frequency, urgency) and absence of vaginal discharge 1
Urine analysis provides minimal increase in diagnostic accuracy when typical symptoms are present 1
Urine culture is recommended for:
- Suspected acute pyelonephritis
- Symptoms that do not resolve or recur within 4 weeks after treatment
- Women with atypical symptoms
- Pregnant women 1

Using antibiotics not recommended in guidelines (like doxycycline) may lead to treatment failure 1, 2
Failing to consider local resistance patterns when selecting trimethoprim-sulfamethoxazole 2, 4
Routine post-treatment urinalysis or urine cultures are not indicated for asymptomatic patients 1
Using fluoroquinolones as first-line therapy despite their high efficacy, as this promotes resistance to these important agents needed for more serious infections 2

For women whose symptoms do not resolve by the end of treatment, or recur within 2 weeks, a urine culture and antimicrobial susceptibility testing should be performed 1
Retreatment with a 7-day regimen using another agent should be considered if the initial treatment fails 1