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10.5: Cystitis

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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


    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:

    1. Continuous low dose chemoprophylaxis Nitrofurantoin, Cephalosporin nocte dose for 6-9 months
    2. Post intercourse single dose therapy if UTIs related to intercourse. Antimicrobials as above
    3. “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.
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