Acute Cystitis

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:

  1. E. coli (about 80%)
  2. Staphylococcus saprophyticus
  3. Klebsiella
  4. Proteus mirabilis
  5. Gonococcus
  6. Enterococci

Symptoms of Acute Cystitis

The symptoms of acute cystitis include the following:

  1. Low grade fever
  2. Frequency
  3. Nocturia
  4. Urgency
  5. Dysuria
  6. Haematuria
  7. Cloudy and foul smelling urine
  8. Low back and suprapubic pain

Signs

The following are the signs of acute cystitis:

  1. Low grade fever
  2. Suprapubic tenderness
  3. 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 seļæ¾vere 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.