MANAGEMENT OF UNCOMPLICATED CYSTITIS IN WOMEN IN FAMILY PRACTICE

  • Josip Car Inštitut za varovanje zdravja Republike Slovenije Trubarjeva 2 1000 Ljubljana
  • Tanja Marinko Zdravstveni dom Ljubljana Šiška Derčeva 5 1000 Ljubljana
Keywords: urinary tract infections, family practice, treatment

Abstract

Background. Acute uncomplicated cystitis in women is one of the most common infections in women. Recent studies have made treatment of acute uncomplicated cystitis in women shorter and less complicated. We summarize the literature on treatment of women with acute uncomplicated cystitis in family practice and outline the approach to investigations and follow-up visits.

Conclusions. Women with characteristic clinical picture of acute uncomplicated cystitis shall be treated in family practice empirically with trimethoprim-sulfamethoxazole (160 mg/800 mg/12 h) for three days. There is no need for follow-up visit after successful treatment. Patients with known allergy or resistance to trimethoprim-sulfamethoxazole are treated with second choice drugs – fluoroquinolons (norfloxacin 400 mg twice a day, ciprofloxacin 250 mg twice a day). In the case of uncharacteristic clinical picture for acute cystitis or uncharacteristic laboratory results and in the case of unsuccessful three-day empirical treatment urine culture has to be performed and gynaecological examination as well. The patient should be educated about non-specific treatment and about preventive measures.

Downloads

Download data is not yet available.

References

Kunin CM. Urinary tract infections: Detection, prevention, and management. 5th ed. Baltimore: Williams and Wilkins, 1997: 1–419.

Zdravstveno statistični letopis Slovenija. Zdrav Var 1997; 36: Suppl 4: 1–458.

Hooton TM, Scholes D, Hughes JP, Winter C, Roberts PL, Stapleton AE et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med 1996; 335: 468–74.

Foxman B, Frerichs RR. Epidemiology of urinary tract infection: I. Diaphragm use and sexual intercourse. Am J Public Health 1985; 75: 1308–13.

Sobel JD. Pathogenesis of urinary tract infection. Role of host defenses. Infect Dis Clin North Am 1997; 11: 531–49.

Fowler JE Jr., Pulaski ET. Excretory urography, cystography, and cystoscopy in the evaluation of women with urinary-tract infection: a prospective study. N Engl J Med 1981; 304: 462–5.

Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med 1993; 329: 1328–34.

Johnson JR, Stamm WE. Urinary tract infections in women: diagnosis and treatment. Ann Intern Med 1989; 111: 906–17.

Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am 1997; 11: 551–81.

Fihn SD, DeWitt DE. Outpatient medicine. 2nd ed. Philadelphia: Saunders, 1998.

Murray PR, Baron EJ. Manual of clinical microbiology. 7th ed. American Society for Microbiology, 1999.

Ditchburn RK, Ditchburn JS. A study of microscopical and chemical tests for the rapid diagnosis of urinary tract infections in general practice. Br J Gen Pract 1990; 40: 406–8.

Bailey BL Jr. Urinalysis predictive of urine culture results. J Fam Pract 1995; 40: 45–50.

Kunin CM, White LV, Hua TH. A reassessment of the importance of »lowcount« bacteriuria in young women with acute urinary symptoms. Ann Intern Med 1993; 119: 454–60.

Stamm WE, Counts GW, Running KR, Fihn S, Turck M, Holmes KK. Diagnosis of coliform infection in acutely dysuric women. N Engl J Med 1982; 307: 463–8.

Komaroff AL. Urinalysis and urine culture in women with dysuria. Ann Intern Med 1986; 104: 212–8.

Nicolle LE. Asymptomatic bacteriuria in institutionalized elderly people: evidence and practice. CMAJ 2000; 163: 285–6.

Hooton TM, Scholes D, Stapleton AE et al. A prospective study of asymptomatic bacteriuria in sexually active young women. N Engl J Med 2000; 343: 992–7.

Geerlings SE, Stolk RP, Camps MJ et al. Asymptomatic bacteriuria may be considered a complication in women with diabetes. Diabetes Mellitus Women Asymptomatic Bacteriuria Utrecht Study Group. Diabetes Care 2000; 23: 744–9.

Lifshitz E, Kramer L. Outpatient urine culture: does collection technique matter? Arch Intern Med 2000; 160: 2537–40.

Holland DJ, Bliss KJ, Allen CD, Gilbert GL. A comparison of chemical dipsticks read visually or by photometry in the routine screening of urine specimens in the clinical microbiology laboratory. Pathology (Phila) 1995; 27: 91–6.

Pauker SG, Kassirer JP. The threshold approach to clinical decision making. N Engl J Med 1980; 302: 1109–17.

Winkens RA, Leffers P, Trienekens TA, Stobberingh EE. The validity of urine examination for urinary tract infections in daily practice. Fam Pract 1995; 12: 290–3.

Baerheim A, Digranes A, Hunskaar S. Equal symptomatic outcome after antibacterial treatment of acute lower urinary tract infection and the acute urethral syndrome in adult women. Scand J Prim Health Care 1999; 17: 170–3.

Saint S, Scholes D, Fihn SD, Farrell RG, Stamm WE. The effectiveness of a clinical practice guideline for the management of presumed uncomplicated urinary tract infection in women. Am J Med 1999; 106: 636–41.

Gupta K, Hooton TM, Stamm WE. Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infections. Ann Intern Med 2001; 135: 41–50.

Gupta K, Hooton TM, Roberts PL, Stamm WE. Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women. Ann Intern Med 2001; 135: 9–16.

Bartlett RC, O’Neill D, McLaughlin JC. Detection of bacteriuria by leukocyte esterase, nitrite, and the automicrobic system. Am J Clin Pathol 1984; 83: 683–7.

Marsik FJ, Owens D, Lewandowski J. Use of the leukocyte esterase and nitrite tests to determine the need for culturing urine specimens from a pediatric and adolescent population. Diagn Microbiol Infect Dis 1986; 4: 181–3.

Morrison MC, Lum G. Dipstick testing of urine—can it replace urine microscopy? Am J Clin Pathol 1986; 85: 590–4.

Sultana RV, Zalstein S, Cameron P, Campbell D. Dipstick urinalysis and the accuracy of the clinical diagnosis of urinary tract infection. J Emerg Med 2001; 20: 13–9.

Bren A, Lindič J. Bakterijske okužbe sečil. In: Kocijančič A, Mrevlje F eds. Interna medicina. 2., dopolnjena izd. Ljubljana: EWO, DZS, 1998: 820–34.

Fihn SD, Johnson C, Roberts PL, Running K, Stamm WE. Trimethoprimsulfamethoxazole for acute dysuria in women: a single-dose or 10-day course. A double-blind, randomized trial. Ann Intern Med 1988; 108: 350–7.

Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis 1999; 29: 745–58.

Baerheim A. Empirical treatment of uncomplicated cystitis. BMJ 2001; 323: 1197–8.

Naber KG. Which fluoroquinolones are suitable for the treatment of urinary tract infections? Int J Antimicrob Agents 2001; 17: 331–41.

MacLean AB. Urinary tract infection in pregnancy. Int J Antimicrob Agents 2001; 17: 273–7.

Jepson RG, Mihaljevic L, Craig J. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews [computer file] 2000 (2): CD001321.

Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in. BMJ 2001; 322: 1571–1.

Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 1993; 329: 753–6.

Ikaheimo R, Siitonen A, Heiskanen T, Karkkainen U, Kuosmanen P, Lipponen P, Makela PH. Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis 1996; 22: 91–9.

Foxman B. Recurring urinary tract infection: incidence and risk factors. Am J Public Health 1990; 80: 331–3.

Nicolle LE, Ronald AR. Recurrent urinary tract infection in adult women: diagnosis and treatment. Infect Dis Clin North Am 1987; 1: 793–806.

Pfau A, Sacks T, Engelstein D. Recurrent urinary tract infections in premenopausal women: prophylaxis based on an understanding of the pathogenesis. J Urol 1983; 129: 1153–7.

Fowler JE Jr, Stamey TA. Studies of introital colonization in women with recurrent urinary infections. VII. The role of bacterial adherence. J Urol 1977; 117: 472–6.

Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents 2001; 17: 259–68.

Herxheimer A. Helping patients take responsibility for their own health. Ann Intern Med 2001; 135: 51–2.

How to Cite
1.
Car J, Marinko T. MANAGEMENT OF UNCOMPLICATED CYSTITIS IN WOMEN IN FAMILY PRACTICE. TEST ZdravVestn [Internet]. 1 [cited 5Aug.2024];72(2). Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/1788
Section
Review