Selecting a Treatment Regimen
ÎFosfomycin 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 for 3 to 7 days is an appropriate choice
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).
ÎThe 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).
Îβ-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.
ÎAmoxicillin or ampicillin should be used for empiric
treatment given their relatively poor efficacy and the very high prevalence of antimicrobial resistance to these agents worldwide (A-III).
bid
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OT