The EAU guidelines recommend the following short-term antibiotics as the first-choice treatment for acute uncomplicated cystitis:
Fosfomycin (3 g single dose): Fosfomycin administered as a single 3 g dose using trometamol is an effective option for treating Uncomplicated UTI . This antibiotic provides convenient dosing and is highly effective against the causative pathogens.
Nitrofurantoin (50 mg every 6 hours) for 7 days.
Nitrofurantoin (100 mg twice daily) for 5-7 days (macrocrystals formulation).
Nitrofurantoin is commonly prescribed for the treatment of uncomplicated cystitis. It demonstrates good efficacy and is well-tolerated by most patients.
Pivmecillinam (400 mg twice daily) for 3 days.
Pivmecillinam (200 mg three times daily) for 5 days.
Pivmecillinam is another recommended antibiotic for the treatment of acute uncomplicated cystitis. It exhibits good efficacy and helps to eradicate the causative pathogens.
Gaps in Current Antimicrobial Therapy:
While the above-mentioned antibiotics are recommended as the first choice by the guidelines, there are certain limitations and gaps in the current antimicrobial therapy for acute uncomplicated UTI.
Fluoroquinolones, such as ciprofloxacin, are not recommended as a first-line treatment due to increasing resistance. They should be reserved for important uses other than acute cystitis. Additionally, fluoroquinolones have the potential for collateral damage, meaning they may affect the normal flora of the body, leading to adverse effects.
Amoxicillin-Clavulanate and Cephalosporins:
Amoxicillin-clavulanate and cephalosporins are not recommended as first-line options due to inferior efficacy and an increasing rate of resistance. These antibiotics may also cause more adverse effects compared to the recommended treatments.
More than half of healthy adult women visit the hospital with acute uncomplicated cystitis at least once in their lifetime.
Escherichia coli is the most common organism responsible for acute uncomplicated UTI, followed by Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis.