Acute Cystitis

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ICD10 CODE: N30

An infection/inflammation involving the bladder, a part of the lower urinary tract. It is a common manifestation of uncomplicated UTI (Urinary Tract Infection) in non- pregnant women.

Uncomplicated cystitis is less common in men and needs to be differentiated from prostatitis and urethritis (sexually transmitted).

Cause

  • Bacterial infection, usually gram negative (from intestinal flora) e.g. Escherichia coli

Clinical features

  • Dysuria (pain and difficulty in passing urine)
  • Urgency of passing urine, frequent passing of small amounts of urine
  • Suprapubic pain and tenderness
  • Pyuria/haematuria (pus/blood in the urine making it cloudy)
  • Foul smelling urine
  • There may be retention of urine in severe infection

Investigations

  • Midstream urine: urine analysis for protein, blood, leucocytes, nitrates, sediment
  • Culture and sensitivity (if resistant/repeated infections)

Diagnostic criteria

  • Symptoms ± leucocytes and/ or nitrates at urine analysis

Differential diagnosis

  • Women: vaginitis
  • Men: urethritis (in young sexually active patients), prostatitis (fever, chills, malaise, perineal pain, confusion, in older men)

Note: Asymptomatic bacteriuria or pyuria (leucocytes in urine) does not need treatment except in risk groups such as pregnant women, patients undergoing urological interventions and post kidney transplant patients

Management

Treatment LOC

Uncomplicated UTI (cystitis) in non-pregnant women

  • Ensure high fluid intake

First line agents:

  • Nitrofurantoin 100 mg 6 hourly for 5-7 days (advise patient to take after meals)
    • Child: 3 mg/kg/day every 6 hours for 7 days

Second line agents

  • Ciprofloxacin 500 mg every 12 hours for 3-7 days (adults)
    • Children: amoxicillin 125-250 mg 8 hourly for 7 days

If poor response or recurrent infections

  • Refer for investigation of culture and sensitivity and further management
 HC2

Note: For urinary tract infection in pregnancy, see Urinary Tract Infections in Pregnancy

Prevention

  • Improved personal/genital hygiene
  • Pass urine after coitus
  • Drink plenty of fluids