Pharmacologic Therapy

Uncomplicated Cystitis

Uncomplicated cystitis represents the most common of UTIs, is frequently managed in the outpatient setting, and occurs in women of childbearing age. E. coli is the most frequent causal organisms in this setting, but in a minority of cases may be caused by S. saprophyticus, K. pneumoniae, P. mirabilis, Enterococcus spp., and a small percentage of other organsims.9-12 As such, treatment in the outpatient setting is frequently relegated to a urinalysis and empiric therapy without a urine culture.31" 2 Patients are subsequently followed up for resolution of signs and symptoms. One significant benefit of treatment in the setting of uncomplicated cystitis is that treatment duration can be less than 7 days, and often may be 3 days or even 1 day.

Although treatment duration of 1 day is advantageous because it strictly limits adverse events and drug interactions, and increases compliance, health care providers should know that 3-day courses of fluoroquinolones and trimetho prim-sulfameth-oxazole are superior to single-doses in terms of cure rates in uncomplicated UTIs.10,33 For acute uncomplicated UTIs, it is reasonable to pursue a 1-day course of therapy. Which agent to choose empirically partly hinges on known resistance rates in the geographic region, particularly E. coli resistance to trimethoprim-sulfamethoxazole.9,34,35 No consensus has been reached on what percentage of E. coli isolates resistant to trimethoprim-sulfamethoxazole should preclude its use; however, a model has been created that suggests that this threshold resistant rate is between 19% and 21% in the empiric setting.36

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