UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Updated Guidelines for Acute Uncomplicated Cystitis in Women

Keywords: cystitis, uti, nitrofurantoin, urinary tract infection (PubMed Search)

Posted: 1/3/2012 by Bryan Hayes, PharmD (Emailed: 1/7/2012) (Updated: 1/7/2012)
Click here to contact Bryan Hayes, PharmD

In 2011, updated treatment guidelines were published for acute uncomplicated cystitis and pyelonephritis in women. The recommendations differ from the previous iteration due to increased E. Coli resistance. The good news is we have been ahead of the curve in changing our prescribing habits.

Cystitis (recommendations in order of preference)

  1. Nitrofurantoin 100 mg BID X 5 days
  2. Bactrim DS 1 tab BID X 3 days (not recommended when resistance rate is > 20% - UMMC is 32%)
  3. Fosfomycin (not currently available at UMMC)
  4. Fluoroquinolones not recommended as first-line therapy due to “propensity for collateral damage”
  5. Beta-lactam agents, including amoxicillin-clavulanate, cefdinir, cefaclor, and cefpodoxime-proxetil, in 3–7-day regimens are appropriate choices for therapy when other recommended agents cannot be used. Other beta-lactams, such as cephalexin, are less well studied but may also be appropriate in certain settings.

Take home points:

  • Be familiar with your institution’s antibiogram
  • Use nitrofurantoin first-line for uncomplicated cystitis in women (it is contraindicated with CrCl < 60 mL/min)
  • Consider beta-lactams such as Augmentin or Vantin (cefpodoxime) in patient’s with kidney injury


Gupta K, et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases 2011;52(5):e103-e120