Uncomplicated acute cystitis in women
Acute bacterial cystitis in non-pregnant women without structural urinary tract anomalies or immunosuppression. Drug choice depends on regional E. coli resistance.
ICD-10 N30.04 drugs
Also known as: Acute cystitis
Drugs used for this condition
- AFosfomycinFirst line · Other antibacterialsFirst-line for uncomplicated acute cystitis in women per IDSA 2010 and Spanish SEMI 2022. Single 3 g oral dose of fosfomycin trometamol (Monurol) 2 hours before bedtime with an empty bladder. Covers E. coli (including some ESBL strains), Klebsiella, Proteus, Enterobacter. Efficacy 80–90%. Advantage over fluoroquinolones – lower resistance (E. coli to ciprofloxacin in Spain reaches 25–35%, to fosfomycin 2–5%).
- BCo-trimoxazoleFirst line · Sulfonamide-trimethoprim combinationCo-trimoxazole 160/800 mg twice daily for 3 days is one of the first-line options for acute uncomplicated cystitis in non-pregnant women in regions where local E. coli resistance is below 20%. IDSA/ESCMID 2011 lists the drug alongside nitrofurantoin and fosfomycin. In Russia, 2022 monitoring data show E. coli resistance to co-trimoxazole above 25%, so the drug is more often used as an alternative when susceptibility is confirmed.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DNorfloxacinNot recommended · Second-generation fluoroquinoloneFor acute uncomplicated cystitis in non-pregnant women, norfloxacin is not recommended as first line. FDA 2018 and EMA 2019 restricted fluoroquinolones because of severe and potentially irreversible adverse effects (tendinitis, tendon rupture, peripheral neuropathy, aortic aneurysm). When alternatives are available (nitrofurantoin, fosfomycin, trimethoprim-sulfamethoxazole), fluoroquinolones are not used for simple cystitis. Norfloxacin is reserved for confirmed resistance to first-line agents in patients without risk factors for fluoroquinolone adverse effects.
- FGentamicinNot recommended · Aminoglycoside antibioticFor uncomplicated acute cystitis in non-pregnant outpatient women, gentamicin is not prescribed. Parenteral administration carrying nephrotoxicity and ototoxicity risks is not justified when effective oral options exist (nitrofurantoin, fosfomycin, trimethoprim-sulfamethoxazole). NICE NG109 2018 and IDSA classify aminoglycosides as inpatient reserve agents, not as outpatient cystitis therapy.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit