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PostPosted: 05 Nov 2014 04:33 
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Importance: Urinary tract infection is among the most common reasons for an outpatient visit and antibiotic use in adult populations.
The increasing prevalence of antibacterial resistance among community uropathogens affects the diagnosis and management of this clinical syndrome.

Objectives
To define the optimal approach for treating acute cystitis in young healthy women and in women with diabetes and men and to define the optimal approach for diagnosing acute cystitis in the outpatient setting.
Evidence Review

Evidence for optimal treatment regimens was obtained by searching PubMed and the Cochrane database for English-language studies published up to July 21, 2014.

Findings

Twenty-seven randomized clinical trials (6463 patients), 6 systematic reviews, and 11 observational studies (252 934 patients) were included in our review.

Acute uncomplicated cystitis in women can be diagnosed without an office visit or urine culture.
Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days), nitrofurantoin monohydrate/macrocrystals (100 mg twice daily for 5-7 days), and fosfomycin trometamol (3 g in a single dose) are all appropriate first-line therapies for uncomplicated cystitis.

Fluoroquinolones are effective for clinical outcomes but should be reserved for more invasive infections. β-Lactam agents (amoxicillin-clavulanate and cefpodoxime-proxetil) are not as effective as empirical first-line therapies.
Immediate antimicrobial therapy is recommended rather than delayed treatment or symptom management with ibuprofen alone. Limited observational studies support 7 to 14 days of therapy for acute urinary tract infection in men.

Based on 1 observational study and our expert opinion, women with diabetes without voiding abnormalities presenting with acute cystitis should be treated similarly to women without diabetes.

Conclusions and Relevance

Immediate antimicrobial therapy with trimethoprim-sulfamethoxazole, nitrofurantoin, or fosfomycin is indicated for acute cystitis in adult women.
Increasing resistance rates among uropathogens have complicated treatment of acute cystitis. Individualized assessment of risk factors for resistance and regimen tolerability is needed to choose the optimum empirical regimen.

Ref: JAMA Oct 2014.

G Mohan.


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PostPosted: 07 Nov 2014 21:10 
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Mohan,

This article suggests that all acute cystitis including the uncomplicated ones are due to infection. Am I mistaken in thinking that symptoms of uncomplicated acute cystitis can also be due to minor trauma of the urethra or from very acidic urine?


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PostPosted: 09 Nov 2014 02:55 
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You are correct Badri, Thank you .

Allow me to add:


In women who have had, or are going through, the menopause, the lining of the urethra and the bladder become thinner because of a lack of the hormone oestrogen. The thin lining is more likely to become infected or damaged.
Women also produce fewer vaginal secretions after the menopause, which means that bacteria are more likely to multiply.

Damage or irritation

Cystitis can also be caused by damage or irritation in the area around the urethra in both men and women.

This damage or irritation could be the result of:
sex
chemical irritants – for example, in perfumed soap or talcum powder
other bladder or kidney problems, such as a kidney infection or prostatitis
diabetes
damage caused by a catheter.

ACIDIC URINE.

pH-The range is 4.5 to 8, but urine is commonly acidic (ie 5.5-6.5) due to metabolic activity.

Acidic urine (low pH) may be caused by diet (eg, acidic fruits such as cranberries) and uric acid calculi.

Urine pH generally reflects the blood pH but in renal tubular acidosis (RTA) this is not the case. In type 1 RTA (distal) the urine is acidic but the blood alkaline.
In type 2 (proximal) the urine is initially alkaline but becomes more acidic as the disease progresses.
Alkaline urine (high pH) is seen in the initial stages of type 2 RTA and also with infection with urease-splitting organisms, and may be associated with the formation of stag-horn calculi.

G. MOHAN.


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