What is the ICD 10 code and treatment for acute simple cystitis in a female?

ICD-10 Code and Treatment for Acute Simple Cystitis in Females

ICD-10 Code

The ICD-10 code for acute simple (uncomplicated) cystitis in females is N30.00 (acute cystitis without hematuria) or N30.01 (acute cystitis with hematuria). 1

First-Line Treatment Recommendations

For acute uncomplicated cystitis in women, nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for 5 days is the preferred first-line treatment due to minimal resistance patterns and excellent efficacy. 1, 2

Primary Treatment Options (in order of preference):

• Nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for 5 days - This is the most strongly recommended first-line agent with minimal collateral damage and resistance rates 1, 2

• Fosfomycin trometamol 3 grams as a single oral dose - Highly convenient single-dose therapy, though slightly lower efficacy than multi-day regimens 1, 3

  • FDA-approved specifically for uncomplicated UTIs in women 3
  • Should be avoided if early pyelonephritis is suspected 1

• Trimethoprim-sulfamethoxazole 160/800 mg (one double-strength tablet) twice daily for 3 days - Only use if local E. coli resistance rates are <20% or if the organism is known to be susceptible 1

  • Avoid if this agent was used for UTI in the previous 3 months 1

• Pivmecillinam 400 mg three times daily for 3-5 days - Good option where available (primarily Europe), though with slightly lower efficacy 1, 2

Alternative Options When First-Line Agents Cannot Be Used

• Cephalosporins (e.g., cefadroxil 500 mg twice daily for 3 days) - Use only if local E. coli resistance is <20% 1, 2

• Fluoroquinolones (ciprofloxacin, levofloxacin) - Reserve for more serious infections due to collateral damage concerns (C. difficile, tendinopathy) and increasing resistance 1, 2, 4

  • Should NOT be first-line despite high efficacy 2

Diagnostic Approach

Diagnosis can be made clinically based on acute-onset dysuria plus urinary frequency/urgency in the absence of vaginal discharge or irritation. 1, 5

When to obtain urine culture:

• Suspected pyelonephritis (fever, flank pain) 1
• Symptoms not resolving or recurring within 4 weeks after treatment 1
• Atypical symptoms 1
• Pregnancy 1
• Recurrent UTIs (≥3 UTIs/year or 2 UTIs in 6 months) 1

When urine culture is NOT needed:

• Typical symptoms in otherwise healthy premenopausal women 1, 5
• Routine post-treatment follow-up in asymptomatic patients 1

Important Clinical Considerations

Avoid β-lactams (including amoxicillin/ampicillin) for empirical treatment due to inferior efficacy and high resistance rates. 2

For women with mild to moderate symptoms, symptomatic therapy with NSAIDs (e.g., ibuprofen) may be considered as an alternative to antimicrobials after shared decision-making. 1

Treatment Failure Management

If symptoms persist or recur within 2 weeks, obtain urine culture and assume the organism is not susceptible to the initial agent. 1

• Retreat with a 7-day regimen using a different antimicrobial class 1
• Do not use the same agent that failed initially 1

Key Pitfalls to Avoid

• Do not routinely perform cystoscopy or imaging in women <40 years with recurrent UTI and no risk factors 1
• Do not use amoxicillin or ampicillin empirically - high resistance rates make these ineffective 2
• Avoid nitrofurantoin if pyelonephritis is suspected - inadequate tissue penetration 1
• Consider local antibiogram patterns - resistance varies by region and should guide empirical choices 1