From the Guidelines
Acute cystitis is a specific type of urinary tract infection (UTI) that affects the bladder, and it should be treated with short-course antibiotics, such as nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or fosfomycin as a single dose, as recommended by the American College of Physicians 1. While all cases of acute cystitis are UTIs, not all UTIs are cystitis. UTIs can occur in any part of the urinary system including the urethra (urethritis), bladder (cystitis), ureters, or kidneys (pyelonephritis). The key differences between acute cystitis and other types of UTIs are:
- Location of the infection: cystitis affects the bladder, while other UTIs can affect other parts of the urinary system
- Severity of symptoms: cystitis typically presents with symptoms like frequent urination, burning during urination, lower abdominal pain, and cloudy or bloody urine
- Treatment approach: cystitis can typically be treated with shorter courses of oral antibiotics, while upper urinary tract infections like pyelonephritis require longer antibiotic courses and sometimes hospitalization
Some important considerations for treatment include:
- Completing the full course of antibiotics, even if symptoms improve quickly
- Drinking plenty of water to help flush bacteria from the system
- Using over-the-counter pain relievers like phenazopyridine (Azo) to manage discomfort
- Monitoring for signs of worsening symptoms, such as fever or back pain, which may indicate the infection has spread to the kidneys
It's also worth noting that the European Association of Urology guidelines recommend using a combination of antibiotics, such as amoxicillin plus an aminoglycoside, for the treatment of complicated UTIs 1. However, for uncomplicated cystitis, the American College of Physicians recommends short-course antibiotics, such as nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or fosfomycin as a single dose 1. The AUA/CUA/SUFU guideline also recommends using first-line therapy, such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin, dependent on the local antibiogram for the treatment of symptomatic UTIs in women 1.
In terms of specific treatment options, the most recent and highest quality study recommends:
- Nitrofurantoin for 5 days
- Trimethoprim-sulfamethoxazole for 3 days
- Fosfomycin as a single dose These options are recommended for the treatment of uncomplicated cystitis, and the choice of antibiotic should be based on the local antibiogram and the patient's specific needs.
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.
The main difference between acute cystitis and UTI is the location and severity of the infection. Acute cystitis refers to an infection of the bladder, typically caused by bacteria such as Escherichia coli or Staphylococcus saprophyticus. UTI (Urinary Tract Infection) is a broader term that encompasses infections of the entire urinary system, including the kidneys, ureters, bladder, and urethra.
- Acute cystitis is a specific type of UTI that is limited to the bladder.
- UTI can be further divided into:
- Uncomplicated UTI: occurs in individuals with a normal urinary tract and no underlying medical conditions.
- Complicated UTI: occurs in individuals with an abnormal urinary tract or underlying medical conditions. Based on the provided drug label 2, ciprofloxacin is indicated for the treatment of Urinary Tract Infections and Acute Uncomplicated Cystitis in females.
From the Research
Definition and Diagnosis
- Acute cystitis and urinary tract infections (UTIs) are related conditions, with acute cystitis being a type of UTI that affects the bladder 3.
- Acute uncomplicated cystitis is characterized by frequency and dysuria in an immunocompetent woman of childbearing age who has no comorbidities or urologic abnormalities 3.
- A urinalysis, but not urine culture, is recommended in making the diagnosis of acute uncomplicated cystitis 3.
Treatment Options
- 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 4.
- 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 5.
- Nitrofurantoin retains antimicrobial activity against multidrug-resistant urinary Escherichia coli from US outpatients 6.
Guideline Concordance
- Clinical practice guidelines from the Infectious Diseases Society of America recommend nitrofurantoin, trimethoprim-sulfamethoxazole, and Fosfomycin as first-line antibiotic treatments and discourage the use of fluoroquinolone antibiotic agents 7.
- The overall concordance rate with Infectious Diseases Society of America guidelines for the treatment of uncomplicated urinary tract infections in women was 58.4% and increased from 48.2% in 2015 to 64.6% in 2019 7.
- Guideline discordance continues in the treatment of uncomplicated urinary tract infections with the overuse of fluoroquinolones and the underuse of first-line antibiotic agents 7.
Comparison of Acute Cystitis and UTI
- Acute cystitis is a type of UTI that affects the bladder, while UTI is a broader term that encompasses infections of the entire urinary tract 3.
- The treatment options for acute cystitis and UTI may differ depending on the severity and location of the infection, as well as the presence of underlying medical conditions 4, 3.