Acute Cystitis
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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
Uncomplicated UTI (cystitis) in non-pregnant women
- Ensure high fluid intake
First line agents:
- Nitrofurantoin 100 mg every 12 hours (every 6 hours if severe) for 5-7 days
- 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
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