Selecting a Treatment Regimen
ÎÎFosfomycin tromethamine 3 g single-dose is an appropriate
choice for therapy where it is available due to minimal
resistance and propensity for collateral damage, but it appears
to have inferior efficacy compared with standard short-course
regimens according to submitted data (A-I).
ÎPivmecillinam 400 mg bid for 3 to 7 days is an appropriate choice
Î
for therapy in regions where it is available (availability limited to
some European countries; not licensed and/or available for use
in North America), due to minimal resistance and propensity for
collateral damage, but it may have inferior efficacy compared with
other available therapies (A-I).
ÎÎThe fluoroquinolones ofloxacin, ciprofloxacin, and levofloxacin
in 3-day regimens are highly efficacious (A-I) but have a
propensity for collateral damage and should be reserved for
important uses other than acute cystitis. They should thus be
considered alternative antimicrobials for acute cystitis (A-III).
ÎÎβ-Lactam agents including amoxicillin-clavulanate, cefdinir,
cefaclor, and cefpodoxime-proxetil in 3- to 7-day regimens
are appropriate choices for therapy when other recommended
agents cannot be used (B-I). Other β-lactams, such as
cephalexin, are less well studied but may also be appropriate
in certain settings (B-III). The β-lactams generally have inferior
efficacy and more adverse effects compared to other urinary
tract infection (UTI) antimicrobials (B-I). For these reasons,
β-lactams other than pivmecillinam should be used with
caution for uncomplicated cystitis.
ÎÎAmoxicillin or ampicillin should NOT be used for empiric
treatment given their relatively poor efficacy and the very
high prevalence of antimicrobial resistance to these agents
worldwide (A-III).
