Introduction to Acute Cystitis
Acute cystitis is an acute inflammation of the bladder.
Women are affected 10 times more than men due to the shortness of their urethra compared to that of men.
40% -50% of all women will develop cystitis in their lifetime.
The ascending faecal-perineal-urethral route is the primary mode of infection. Occasionally sexually transmitted organisms are involved.
Risk factors include urethral catheterization and diabetes
Causes of Acute Cystitis
The causes of acute cystitis include the following:
- E. coli (about 80%)
- Staphylococcus saprophyticus
- Klebsiella
- Proteus mirabilis
- Gonococcus
- Enterococci
Symptoms of Acute Cystitis
The symptoms of acute cystitis include the following:
- Low grade fever
- Frequency
- Nocturia
- Urgency
- Dysuria
- Haematuria
- Cloudy and foul smelling urine
- Low back and suprapubic pain
Signs
The following are the signs of acute cystitis:
- Low grade fever
- Suprapubic tenderness
- Haematuria
Investigations
- Urinalysis
- Mid-stream urine for culture and sensitivity
- FBC
- FBS
- Imaging of urinary tract in recurrent or persistent cases to exclude anatomical abnormalities, lower urinary tract obstruction etc.
- Urethrocystoscopy in selected cases
Treatment for Acute Cystitis
Treatment Objectives
Treatment objectives of acute cystitis include the following:
- To eradicate infection
- To prevent recurrence
- To relieve pain and complications
Non-pharmacological treatment
- Liberal oral fluids to encourage good urinary output
- Pre-coital and post-coital emptying of the bladder
- Personal hygiene and proper cleaning after defaecation especially in females
Pharmacological treatment
A. Acute uncomplicated cystitis (absence of fever and flank pain)
1st Line Treatment
Evidence Rating: [A]
Nitrofurantoin, oral,
- Adults: 100 mg 6 hourly for 5-7 days
- Children:
- 12-18 years; 50 mg 6 hourly for 7 days
- 3 months-12 years; 750 micrograms/kg 6 hourly
2nd Line Treatment
Evidence Rating: [A]
Ciprofloxacin, oral,
- Adults: 500 mg 12 hourly for 5-7 days
- Children:
- 12-18 years; 250-750 mg 12 hourly
- 1 month-12 years; 7.5 mg /kg 12 hourly (dose doubled in severe cases)
- Neonates: 7.5 mg/kg 12 hourly
Or
Cefuroxime, oral,
- Adults: 500 mg 12 hourly for 5-7days
Children:- 12-18 years; 250 mg 12 hourly (dose reduced to 125 mg 12 hourly in lower urinary tract infections)
- 2-12 years; 15 mg/kg 12 hourly (max. 250 mg 12 hourly)
- 3 months-2 years; 10 mg/kg 12 hourly (max. 125 mg 12 hourly)
And
Evidence Rating: [C]
Mist Potassium citrate, oral,
- 10 ml 8 hourly if urine is acidic (pH of 6 or below). To reduce bladder pain and dysuria.
Note
Monitor potassium levels and avoid in hyperkalaemia.
Do not give with ciprofloxacin.
Or
Paracetamol, oral, 500 mg-1g 6-8 hourly when required
B. For symptomatic cystitis and UTI in pregnancy
Cefuroxime, oral,
Adults: 500 mg 12 hourly for 5-7days
And
Evidence Rating: [C]
Mist Potassium citrate, oral,
- 10 ml 8 hourly if urine is acidic (pH of 6 or below). To reduce bladder pain and dysuria.
Note
Monitor potassium levels and avoid in hyperkalaemia.
Do not give with ciprofloxacin.
Referral Criteria
Refer all cases, which require cystoscopy and all cases of persistent haematuria, recurrent cystitis or bacterial resistance to the specialist.