Approach to managing acute cystitis in nonpregnant adult females
The approach to managing acute cystitis in nonpregnant adult females1 depends on their age:
- For patients younger than 65 years, discuss the option of initial nonantibiotic therapy (analgesia).
- For patients 65 years and older, treat with an antibiotic and offer analgesia.
Many clinicians advise increased fluid intake during an episode of acute cystitis to help manage the symptoms, but evidence to support this advice is lacking.
The efficacy of urinary alkalinising agents for the symptomatic treatment of acute cystitis has not been established in trials but some patients find them useful for symptom reliefO'Kane, 2016. Urinary alkalinising agents significantly reduce the antimicrobial effect of nitrofurantoin, and they should not be used with quinolones (eg ciprofloxacin) because there is an increased risk of crystalluriaCunha, 2017O'Kane, 2016.
Cranberry products, ascorbic acid and methenamine hippurate are not effective for the treatment of acute cystitisNational Institute for Health and Care Excellence (NICE), October 2018.