From the Guidelines
Uncomplicated cystitis in women should be treated with a short course of oral antibiotics, with first-line options including nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or fosfomycin as a single dose, as recommended by the most recent guidelines 1.
Treatment Options
The treatment of uncomplicated cystitis in women typically involves a short course of oral antibiotics. The following are first-line treatment options:
- Nitrofurantoin (Macrobid) 100 mg twice daily for 5 days
- Trimethoprim-sulfamethoxazole (Bactrim) 160/800 mg twice daily for 3 days (if local resistance rates are less than 20%)
- Fosfomycin (Monurol) 3 grams as a single dose These antibiotics are effective against Escherichia coli, which accounts for more than 75% of all bacterial cystitis cases 1.
Alternative Options
Alternative treatment options include:
- Cephalexin (Keflex) 500 mg four times daily for 5-7 days
- Amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days However, fluoroquinolones like ciprofloxacin should be reserved for more complicated cases due to resistance concerns and side effects 1.
Additional Recommendations
Patients should increase fluid intake and can take phenazopyridine (Pyridium) 200 mg three times daily for 2 days to relieve painful urination symptoms. Most women experience symptom improvement within 2-3 days of starting antibiotics. If symptoms persist beyond 48-72 hours or worsen at any point, further evaluation is necessary 1.
From the FDA Drug Label
Fosfomycin tromethamine granules for oral solution is indicated only for the treatment of uncomplicated urinary tract infections (acute cystitis) in women due to susceptible strains of Escherichia coli and Enterococcus faecalis. The recommended dosage for women 18 years of age and older for uncomplicated urinary tract infection (acute cystitis) is one sachet of fosfomycin tromethamine granules for oral solution.
The treatment of uncomplicated cystitis in women can be done with fosfomycin tromethamine granules for oral solution. The recommended dosage is one sachet for women 18 years of age and older. Key points to consider are:
- The drug is only indicated for uncomplicated urinary tract infections (acute cystitis) in women.
- It is effective against susceptible strains of Escherichia coli and Enterococcus faecalis 2.
- The dosage can be taken with or without food, but the granules should always be mixed with water before ingesting 2.
From the Research
Diagnosis and Treatment
- The diagnosis of acute uncomplicated cystitis can be made based on symptoms such as 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 3.
- Guidelines recommend three options for first-line treatment of acute uncomplicated cystitis: fosfomycin, nitrofurantoin, and trimethoprim/sulfamethoxazole (in regions where the prevalence of Escherichia coli resistance does not exceed 20 percent) 3, 4.
Antibiotic Treatment
- Beta-lactam antibiotics, amoxicillin/clavulanate, cefaclor, cefdinir, and cefpodoxime are not recommended for initial treatment because of concerns about resistance 3.
- A 5-day course of 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.
- A single oral dose of fosfomycin trometamol is the antibiotic therapy of choice for an episode of acute uncomplicated cystitis 4.
Treatment Duration and Concordance with Guidelines
- The duration of most prescriptions for trimethoprim/sulfamethoxazole, nitrofurantoin, and fluoroquinolones is longer than guidelines recommendations 6.
- Older age and presence of diabetes are independently associated with longer treatment duration 6.
- There is low concordance with the updated guidelines for both the choice of drug and duration of therapy for uncomplicated cystitis in primary care 6.
Non-Antibiotic Therapy and Recurrent Infections
- Non-antibiotic therapy has also become an option which should be discussed and offered to the patient 7.
- In patients suffering from recurrent uncomplicated cystitis, individual risk factors and possible behavioral changes should first be taken into account 7.
- Non-antimicrobial prophylactic strategies shown to be successful in well-designed clinical studies are the next options 7.