Management of Acute Bacterial Cystitis, Approach in non pregnant females

Diagnosis

can be made when symptoms and signs are present, in addition to pyuria
symptoms include : Urgency, Frequency, Burning micturation
urine analysis

                              WBCs > 5 hpf
                              Bacteria
                              Nitrite Positive

      3. urine culture
E coli is the most common causative organism
differentiation between complicated and non complicated infection

complicated infection : when

Immunosuppresed : DM, HIV
Indwelling catheter
Urinary obstruction
Congenital anomalies : vesicoureteric reflux, pelviureteric junction obstruction
Sones
Treatment

In non complicated cases

Initial empirical therapy

Nitrofurantoin
                             100 mg twice daily for 5 days
Trimethoprim-Sulfamethoxazole
                             160/800 mg twice daily for 3 days
Fosfomycin         3 g single dose ( less effective)
Basic concepts of treatment


Floroquinolones are not the first line of treatment
Amoxicillin & Ampicillin should not be used as empirical treatment
alternative empirical therapy includes

           Floroquinolones for 5 days
           Beta lactams for 7 days
Adjust antibiotics based on urine culture