10.5: Cystitis
- Page ID
- 15630
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Clinical Presentation
- frequency and urgency
- suprapubic and back pain
- dysuria
- no pyrexia
- elderly patients may present with sudden onset of incontinence and/or smelly urine
Treatment
Three day course of treatment is sufficient to eliminate uncomplicated cystitis completely Single dose therapy only 70% effective.
Agents used:
- Fluoroquinolones
- Co-amoxiclav
- Cephalosporins
- Nitrofurantoin
Recurrent Cystitis
- recurrent cystitis in females is very common and is usually reinfection
General Measures
- good fluid intake
- local hygiene
- sexual intercourse
- avoid before and after intercourse
- avoid spermicidal creams and diaphragm contraceptives
- topical oestrogens for atrophic vaginitis
- treat constipation
Specific Measures
Three options:
- Continuous low dose chemoprophylaxis Nitrofurantoin, Cephalosporin nocte dose for 6-9 months
- Post intercourse single dose therapy if UTIs related to intercourse. Antimicrobials as above
- “Self-start” Therapy. Patient has supply of treatment (usually Fluoroquinolone), when symptoms of cystitis begin send urine specimen for culture and initiate therapy, attend doctor few days later when culture result available.