Urinary tract infections are a common infection in female patients, and the incidence is very high, and it is documented that female patients are infected at least once in their lifetime.
Acute simple cystitis (also known as "simple cystitis") is a type of urinary tract infection, particularly in a host with normal urinary tract anatomy and normal immune function. Typical symptoms are dysuria, frequency, urgency, or suprapubic pain, but no systemic illness (e.g., fever, chills, or vomiting) or upper urinary tract involvement (e.g., flank pain or costovertebral angle tenderness). However, if fever, chills, vomiting, and low back pain are present, pyelonephritis is considered.
*One of the main first-line medications for acute simple cystitis is oral nitrofurantoin for 5 days. If nitrofurantoin cannot be used, fosfomycin is an acceptable alternative. It is important to note that nitrofurantoin and fosfomycin should be avoided if early pyelonephritis is suspected, as they are less permeable to drugs to the renal parenchyma. Trimethoprim-sulfamethoxazole (chloryancin) may also be used empirically as a first-line agent unless local Enterobacteriaceae (e.g., Escherichia coli) resistance is greater than 20% or in patients with trimethoprim-sulfamethoxazole** infection within the past 3 months.
The following are oral antibiotics for cystitis and pyelonephritis.
The doses listed in this table are for creatinine clearance 60. Abbreviations: DS, Double Strength; TMP-SMX, trimethoprim-sulfamethoxazole.
aThe duration of cystitis is based on guidelines for women. For simple cystitis in men, if there is no evidence of prostatitis, a duration of approximately 7 days is considered.
Oral-lactams such as amoxicillin, clavulanate or cefopoxime are effective second-line agents for urinary tract infections. They are considered second-line drugs because of limited data suggesting that they are less effective and require a longer administration time compared to other drugs. The previously listed first-line options should only be used if they are not feasible due to allergies, availability, or drug resistance. Fluoroquinolones, such as ciprofloxacin, are generally effective for urinary tract infections, but if other oral alternatives are available, they are not recommended as first-line agents for uncomplicated cystitis. This is due to their *** and the increase in the rate of quinolone resistance to mitigate. They are specifically used for more serious infections, such as pyelonephritis.
Pregnancy can affect the threshold of urinary tract infections and the type of antibiotics used; Therefore, if it is difficult to determine the likelihood of pregnancy based on medical history alone, it is important to take a pregnancy test. Antibiotics taken by mouth during pregnancy are as follows:
The risk-benefit balance needs to be assessed by the personal use of any medication in the patient. If there are any concerns, consider involving their obstetrician.
An FDA pregnancy risk category: Category A: No risk in human studies Category B: No risk in animal studies Category: Risk cannot be ruled out. There are no satisfactory studies in pregnant women, but animal studies have shown risks to the fetus; The potential benefit of the drug may be Class D: Risk Evidence. Studies in pregnant women have shown that there is a risk to the fetus; The potential benefits of the drug may outweigh the risks. Studies in pregnant women have shown that there is a risk to the fetus; and or fetal anomalies in human or animal studies. The risks of the drug outweigh the potential benefits.
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