Short-course therapy of acute cystitis: a brief review of therapeutic strategies

Acute cystitis is one of the commonest medical problems encountered by prim ary care physicians. It affects more women than men (8:1), but the incidenc e among men is increasing. Uncomplicated cystitis by definition occurs in h ealthy patients with a normal urinary tract, whereas complicated cystitis i mplies a predisposing or underlying condition. A narrow range of aetiologic al agents is responsible for most uncomplicated cystitis in women (Escheric hia coil in 80% of cases). Recently, however, pathogens usually associated with sexually transmitted disease have been implicated. In women with typic al symptoms of acute uncomplicated cystitis, an abbreviated laboratory work -up followed by empirical therapy is recommended. Single-dose and 3 day reg imens of co-trimoxazole and the quinolones are as effective as longer regim ens and have a higher eradication rate than other commonly used antimicrobi als, Relapse rates are slightly higher with single-dose therapy. With this success rate plus the reduced cost and improved patient compliance, these r egimens have replaced traditional 5 to 14 day courses of treatment. With in creasing resistance of the common urinary pathogens to amoxycillin and, now , co-trimoxazole, the quinolones are a logical choice for empirical therapy of uncomplicated urinary tract infections.