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Key Features

Essentials of Diagnosis

  • Irritative voiding symptoms

  • Patient usually afebrile

  • Positive urine culture; blood cultures may also be positive

General Considerations

  • Most commonly due to the coliform bacteria (especially Escherichia coli) and occasionally gram-positive bacteria (enterococci)

  • The route of infection is typically ascending from the urethra

  • Uncomplicated cystitis in men is rare and implies a pathologic process such as infected stones, prostatitis, or chronic urinary retention requiring further investigation

Clinical Findings

Symptoms and Signs

  • Frequency, urgency, dysuria, suprapubic discomfort, gross hematuria

  • Suprapubic tenderness, no systemic toxicity

Differential Diagnosis

  • In women

    • Vulvovaginitis

    • Pelvic inflammatory disease

  • In men

    • Urethritis

    • Prostatitis

  • In both

    • Pelvic irradiation

    • Chemotherapy (cyclophosphamide)

    • Bladder carcinoma

    • Interstitial cystitis

    • Voiding dysfunction disorders

    • Psychosomatic disorders


Laboratory Tests

  • Urinalysis: pyuria, hematuria, bacteriuria

  • Urine culture: positive, though colony counts > 105/mL not required

  • Urine culture and sensitivity

Imaging Studies

  • Abdominal ultrasonography and cystoscopy help identify underlying problem

  • Obtain CT scan if pyelonephritis, recurrent infections, or anatomic abnormalities are suspected



  • Uncomplicated cystitis: cephalexin, nitrofurantoin, fosfomycin (or sometimes trimethoprim-sulfamethoxazole or a fluoroquinolone) (see regimens below)

    • Cephalexin, 250–500 mg orally every 6 hours for 1–3 days

    • Nitrofurantoin, 100 mg twice daily for 5–7 days

    • Fosfomycin trometamol, 3 g single dose

    • Trimethoprim-sulfamethoxazole, 160/800 mg, 2 tablets orally once (if organism is sensitive)

    • Ciprofloxacin, 250–500 mg orally every 12 hours for 1–3 days

    • Norfloxacin, 400 mg orally every 12 hours for 1–3 days

    • Ofloxacin, 200 mg orally every 12 hours for 1–3 days

  • Increasing (up to 20%) resistance of E coli and other organisms causing UTIs has been noted

  • FDA advises restricting fluoroquinolone use for uncomplicated urinary tract infections

Therapeutic Procedures

  • Symptomatic relief: hot sitz baths or urinary analgesics (phenazopyridine, 200 mg three times daily orally)

  • Uncomplicated cystitis in men warrants elucidation of underlying problem



  • Infections typically respond rapidly to treatment

  • Failure to respond suggests resistance to the selected drug or anatomic abnormalities requiring further investigation


  • Women who have more than three episodes of cystitis per year are considered candidates for prophylactic antibiotic therapy

  • Single dosing at bedtime or at the time of intercourse is the recommended schedule

  • The three most commonly used oral agents are

    • Nitrofurantoin, 100 mg

    • Cephalexin, 250 mg

    • Trimethoprim-sulfamethoxazole, 40 mg/200 mg

  • Minimize the risk of a catheter-associated urinary tract infection in hospitalized patients by

    • Using indwelling catheters only when necessary

    • Ensuring removal of catheters when no longer needed

    • Using antimicrobial catheters in high-risk patients

    • Using external collection devices in select men

    • Identifying significant postvoid residuals ...

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