Current Management Strategies for Uncomplicated and Complicated Cystitis

Acute cystitis is defined as a superficial infection of the bladder mucosa. Approximately 10% of females are diagnosed with cystitis on an annual basis and over 50% of females will have at least one episode of cystitis during their lifetime (Foxman 2002, Foxman et al. 2000). Typically, uncomplicated cystitis occurs in late adolescence and during the second and fourth decades in females with up to 30% of females 20 to 40 years of age having a history of cystitis (Hooton et al. 1996). Symptoms such as fever, chills and flank pain are absent as acute cystitis is not associated with involvement of the upper urinary tracts. Risk factors for acute cystitis include sexual intercourse, the use of spermicides and ascending bowel flora. Males with underlying structural and functional deficiencies of the genitourinary tract may also develop acute cystitis (Krieger et al. 1993). After the initial infection many patients tend to have recurrence with 25% to 50% of patients having another infection within 1 year. Recurrent episodes of cystitis are defined as symptomatic infections that follow the clinical resolution of a previous episode after treatment and their incidence is 3% to 5%. Although the vast majority of patients presenting with cystitis respond promptly to appropriate therapy, early identification and treatment of patients with complicated cystitis remains a significant clinical challenge to physicians and urologists. Herein, we discuss appropriate management strategies for patients presenting with symptoms consistent with both uncomplicated and complicated cystitis. We also place particular emphasis on appropriate antimicrobial treatment regimens for cystitis and discuss emerging patterns of resistance among different uropathogens.