Cystitis is a bacterial infection of the bladder, most often from E. coli, and is very common in women because of the short urethra. In a healthy, nonpregnant woman it is called uncomplicated and is treated with a short course of antibiotics.
Key symptoms
- Burning or pain when urinating
- Frequent, urgent urination with small volumes
- Lower abdominal or suprapubic discomfort
- Cloudy or bloody urine
- No fever or flank pain in simple cystitis
What you find on exam
- Normal temperature and vital signs
- Mild suprapubic tenderness
- No costovertebral angle tenderness
- Pelvic exam if there is vaginal discharge or STI risk
Tests
- Urine dipstick: leukocyte esterase and nitrites
- Urine culture if complicated, recurrent, pregnant, male or treatment failed
- Pregnancy test in women who could be pregnant
- STI testing if symptoms or risk suggest it
Treatment basics
- Nitrofurantoin for 5 days
- Trimethoprim-sulfamethoxazole for 3 days if local resistance is low
- Fosfomycin as a single dose
- Phenazopyridine for 1 to 2 days for burning
- Fluids and review if symptoms persist
Red flags
- Fever, flank pain or vomiting (pyelonephritis)
- Symptoms during pregnancy
- Low blood pressure, confusion or other signs of sepsis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.