From the Guidelines
Acute cystitis is a type of urinary tract infection (UTI) that specifically affects the bladder, and while all cases of acute cystitis are UTIs, not all UTIs are cystitis. The distinction between acute cystitis and UTI is crucial for appropriate treatment and management. UTIs can occur in any part of the urinary system, including the urethra (urethritis), bladder (cystitis), ureters, or kidneys (pyelonephritis) 1. Acute cystitis typically presents with symptoms like:
- Frequent urination
- Burning during urination
- Lower abdominal discomfort
- Cloudy or strong-smelling urine Treatment usually involves antibiotics such as:
- Nitrofurantoin (Macrobid) 100mg twice daily for 5 days
- Trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 3 days
- Fosfomycin (Monurol) as a single 3-gram dose, as recommended by the IDSA/European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline 1. Increasing fluid intake and using pain relievers like phenazopyridine (Pyridium) 200mg three times daily for 2 days can help manage symptoms. Acute cystitis is more common in women due to their shorter urethra, which allows bacteria easier access to the bladder. If symptoms include fever, flank pain, or nausea, this suggests the infection may have spread to the kidneys (pyelonephritis), requiring more aggressive treatment and possibly hospitalization 1. The treatment approach should prioritize short-course antibiotics, with the choice of antibiotic and duration depending on the type of infection and patient factors, as outlined in the best practice advice from the American College of Physicians 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.
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 Difference
- Acute cystitis and UTI (Urinary Tract Infection) are often used interchangeably, but they can have slightly different meanings.
- Acute cystitis typically refers to an infection of the bladder, which is a type of UTI 3.
- UTI is a broader term that can refer to an infection anywhere in the urinary tract, including the kidneys, ureters, bladder, or urethra.
Treatment
- The treatment for acute cystitis and UTI often involves antibiotics, with the choice of antibiotic depending on the severity of the infection, the patient's medical history, and the susceptibility of the bacteria to different antibiotics 4, 5.
- Common antibiotics used to treat acute cystitis and UTI include nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin 3, 6.
- The effectiveness of these antibiotics can vary depending on the patient's renal function, with some antibiotics being more effective in patients with normal renal function and others being more effective in patients with impaired renal function 6.
Guideline Concordance
- There is often low concordance between prescribing practices and clinical guidelines for the treatment of acute cystitis and UTI, with some studies showing that fluoroquinolones are overused and first-line antibiotics are underused 4, 7.
- The concordance rate with guidelines can vary depending on the patient's age, physician specialty, and other factors, with obstetricians-gynecologists and urologists being more likely to prescribe guideline-concordant treatment than other specialties 7.
Antibiotic Resistance
- The overuse of fluoroquinolones and other antibiotics can contribute to the growing rates of antibiotic resistance, making it more difficult to treat acute cystitis and UTI effectively 7.
- Educating physicians about antibiotic resistance and clinical practice guidelines, and providing feedback on prescription habits, can help increase guideline concordance and reduce the use of fluoroquinolones 7.