Vistaril Does Not Treat Bacterial Cystitis
Vistaril (hydroxyzine) is not a treatment for acute bacterial cystitis and should not be used for this indication. Hydroxyzine is an antihistamine with no antimicrobial properties and does not appear in any evidence-based guidelines for the management of urinary tract infections 1, 2, 3.
Standard Treatment for Acute Uncomplicated Cystitis
The appropriate first-line treatments for bacterial cystitis are antimicrobial agents, not antihistamines:
First-Line Antimicrobial Options
- Nitrofurantoin 100 mg twice daily for 5 days is a primary first-line option 1, 2
- Fosfomycin trometamol 3 g as a single dose is equally appropriate as first-line therapy 1, 2
- Pivmecillinam 400 mg three times daily for 3-5 days (where available) 1, 4
Alternative Options
- Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days, but only in regions where E. coli resistance is <20% 1, 3
- Cephalosporins (e.g., cefadroxil 500 mg twice daily for 3 days) if local resistance patterns are favorable 1
The Role of Hydroxyzine in Bladder Conditions
Hydroxyzine does have a role in a completely different bladder condition—interstitial cystitis/bladder pain syndrome (IC/BPS)—which is a chronic pain condition, not an infection 5, 6. This is a critical distinction:
Key Differences Between Bacterial Cystitis and IC/BPS
- Bacterial cystitis is an acute infection requiring antibiotics, presenting with dysuria, frequency, and urgency 1, 3
- IC/BPS is chronic bladder pain lasting >6 months with no infection present, where hydroxyzine may be used as an adjunctive oral therapy to reduce inflammation and histamine-mediated symptoms 5, 6
Common Pitfall to Avoid
Do not confuse interstitial cystitis with bacterial cystitis. If a patient presents with acute urinary symptoms (dysuria, frequency, urgency), the diagnosis is bacterial cystitis requiring antimicrobial therapy 1, 3. Hydroxyzine has no role in this acute infectious process and will not treat the underlying bacterial infection 5, 6. Using hydroxyzine instead of appropriate antibiotics would result in treatment failure and potential progression to pyelonephritis 1.