Acute Uncomplicated Cystitis in an Era of Increasing Antibiotic Resistance: A Proposed Approach to Empirical Therapy

Abstract

Acute uncomplicated lower urinary tract infection (cystitis) is one of the most common and easily cured bacterial infections in women. However, increasing antibiotic resistance complicates its treatment by increasing patient morbidity, costs of reassessment and retreatment, rates of hospitalization, and use of broader-spectrum antibiotics. Guidelines published in 1999 by the Infectious Diseases Society of America (IDSA) recommend trimethoprim-sulfamethoxazole (TMP-SMX) as first-line treatment for acute cystitis—noting, however, that resistance to this agent is increasing [1]. Although public health authorities have increasingly recommended narrow-spectrum antibiotics for treating community-acquired respiratory and urinary tract infections (UTIs) whenever possible, concerns about resistance have resulted in a burgeoning use of fluoroquinolones. In the past few years, use of fluoroquinolones (overall and for UTIs) in ambulatory care has dramatically increased, whereas use of TMP-SMX for UTIs has decreased [2–4]. If trends in the use of fluoroquinolones continue, this crucial class of drugs is likely to become less effective, not only for treating respiratory and urinary tract infections, but also for treating foodborne infections, sexually transmitted diseases, and health care—associated infections.