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Acute simple cystitis in women: fosfomycin trometamol is the first-choice antibiotic

Single-dose oral fosfomycin trometamol is the first-choice antibiotic for acute simple cystitis.

Acute cystitis is a bacterial bladder infection without fever in women over the age of 15. It is generally benign, but the infection only clears up spontaneously within 48 hours in 20% to 25% of cases. In some women, acute simple cystitis recurs frequently, with no harmful consequences other than discomfort.

The diagnosis of acute cystitis is principally based on symptoms. There is an almost 95% likelihood of simple acute cystitis when the following 4 factors are present: burning sensation or difficulty in urinating (dysuria), frequency, absence of vaginal discharge or vaginal pruritis. Sometimes, the symptoms of simple acute cystitis are an urgent need to urinate, abdominal cramps, urine that is red. Simple acute cystitis is more frequent in sexually active young women, but also in post-menopausal women.

As soon as the first symptoms appear, patients are advised to drink a great deal of water and to urinate frequently to obtain relief through regularly flushing out the bladder.

To treat an episode of simple acute cystitis, single-dose oral fosfomycin trometamol is the first-choice antibiotic. The situation is more complicated in cases of pregnancy.

In the event of a recurrence, as soon as the symptoms appear a course of antibiotics is sometimes recommended. Some informed patients are able to self-diagnose the recurrence of simple acute cystitis and take, on their own initiative, a short course of treatment – fosfomycin trometamol in particular – prescribed in advance.

But if symptoms persist for longer than 48 hours or suggest a complicated infection, particularly when there is fever or lumbar pain, the patient should see a doctor.

©Prescrire 1 January 2015

"Acute uncomplicated cystitis in women" Prescrire Int 2015; 24 (156): 22-24. (Pdf, subscribers only).
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