Acute cystitis

Disease Description (Causes and Symptoms)

• Definition summary: Acute cystitis is a lower urinary tract infection in which bacteria multiply in the bladder mucosa and cause inflammation.
• Main causes: More than 80% of cases are caused by Escherichia coli, while Enterococcus, Staphylococcus, and others can also be causes. In many cases, bacteria enter through the urethra and ascend. It is more common in women because the urethra is shorter and the anus, vagina, and urethral opening are close together, making it easier for bacteria to move.
• Pathophysiology: Bacteria ascend from the urethra to the bladder, attach to and multiply on the bladder mucosa, and cause an inflammatory response and bladder irritation symptoms (frequency, urgency, dysuria, etc.). If the infection ascends, it can progress to an upper urinary tract infection such as pyelonephritis.
• Main symptoms: Pain or burning during urination (dysuria), urinary frequency, urinary urgency (a sudden urge to urinate), difficulty urinating, lower abdominal (pelvic) pain, cloudy or foul-smelling urine, and sometimes hematuria. High fever, flank pain, nausea, or vomiting suggests an ascending infection (pyelonephritis).

Treatment Methods

• Diagnostic principles: Diagnosis is mainly based on symptoms. Urinalysis (urine sediment examination and urine chemistry tests — leukocyte esterase and nitrite) may be performed, with urine culture and susceptibility testing when necessary (particularly in men, pregnant women, recurrent cases, or when a complicated urinary tract infection is suspected).
• Drug treatment (reflecting the latest recommendations)
  • Acute cystitis in uncomplicated cases (nonpregnant, otherwise healthy women): Short-course antibiotic treatment is recommended.
    • Recommended options include: nitrofurantoin 100 mg twice daily for 5 days; trimethoprim-sulfamethoxazole (when the local resistance rate is <20%) 1 tablet twice daily for 3 days; or fosfomycin 3 g as a single dose. (Selection depends on local guidelines and resistance rates.)
    • Fluoroquinolones (e.g., ciprofloxacin) are generally not first-line choices and are reserved because of resistance and adverse-effect concerns. However, they may be used in certain situations (limited options, suspected complications, etc.).
  • Men or patients with complications (urethral abnormalities, stones, catheters, immunosuppression, etc.): A longer treatment period (e.g., 7–14 days) and additional evaluation are required.
  • Pregnancy: Caution is needed when selecting medication (in general, safety considerations include penicillins, cephalosporins, and nitrofurantoin [in late pregnancy]). During pregnancy, culture testing is recommended, and treatment should be discussed with an obstetrician and gynecologist.
• Supportive and symptomatic treatment
  • Short-term use of local analgesics (e.g., urinary analgesics such as phenazopyridine) may relieve pain. (Possible adverse effects, such as changes in urine color, should be explained.)
  • Warm sitz baths, adequate fluid intake, and drying and maintaining hygiene of the perineal area after urination.
  • Recurrent cases: Consider low-dose long-term (e.g., 3–6 months) prophylactic antibiotics, short-term postcoital prophylaxis if recurrences are related to sexual intercourse, or non-antibiotic prevention (e.g., certain immunostimulants; data on D-mannose and cranberry are limited).
• Procedures/surgery: Generally not necessary. If an anatomical abnormality (urinary tract malformation, stone, etc.) is suspected in recurrent or complicated infections, additional imaging tests (ultrasound, CT) and urological intervention may be necessary.

Checklist Before an Outpatient Visit (Including Preparation Items and Example Questions)

• Items to bring to the appointment
  • List of current medications and supplements (prescriptions, medication bags, etc.)
  • Previous urinalysis and culture results (if available)
  • History of urinary tract infections (number of episodes, medications used, and treatment duration)
  • Allergy history (especially antibiotic allergies)
  • Possibility of pregnancy or whether you are pregnant (women)
  • Recent sexual history, changes in urination habits, and whether a catheter is being used
  • Record of fever, flank pain, nausea, or vomiting
• Information to provide during the medical history (items to note in advance for the doctor)
  • Date of symptom onset and course (when it started, severity, and factors that worsen or improve it)
  • Urine color, odor, and whether hematuria is present
  • Whether antibiotics have been taken recently (within the past 3 months)
  • Chronic diseases (diabetes, immunosuppression, etc.)
• Preparation for testing
  • Collect a midstream urine sample: discard the initial urine and collect the urine released in the middle of urination.
  • If possible, submit the sample promptly for culture testing.

Examples of General Questions to Ask the Doctor

• "What are the side effects of this medication (the recommended antibiotic)? I am concerned about an allergic reaction."
• "When should my symptoms start to improve after beginning treatment? When should I come back if my symptoms do not improve?"
• "What changes should I make to my lifestyle or hygiene to prevent recurrence?"
• "If I am pregnant, which medications are safe to use?"
• "What should I do until the urine culture results are available?"

Examples of Disease-Specific Questions

• "The same symptoms have recurred several times recently. Which do you recommend: prophylactic antibiotics (low-dose long-term therapy) or non-antibiotic prevention methods?"
• "If my symptoms do not improve within 72 hours or I develop a high fever or flank pain, should I go directly to the emergency room? What symptoms mean that I should seek medical attention immediately?"

Additional Information (Summary)

• Prognosis: With appropriate antibiotic treatment, symptoms generally improve within 48–72 hours. Permanent bladder damage is rare.
• Complications: Pyelonephritis due to an ascending infection, renal abscess, and, rarely, sepsis. Recurrent cystitis and chronic urinary tract infections are possible.
• Prevention: Drink sufficient fluids, wipe from front to back after urination (from the urethra toward the anus), urinate after sexual intercourse, avoid unnecessary vaginal cleansing (douching), and avoid delaying urination.

(Diagnosis and treatment vary depending on the individual’s condition, local antibiotic susceptibility, and clinical status. Follow the treatment plan determined by the treating physician.)