Acute Bacterial Cystitis

Acute Bacterial Cystitis (UTI)

Urinary tract infection (UTI) is a disorder that affects the 35% of women (vs 10-12% of men)at least once in a lifetime. The difference in percentages is given by the fact that the female urethra is very short (5 cm average, i.e. about 1/3 of the male) and it’sopenin is located directly at the level of the vulva. This opening  is “dangerously” close to the vagina and anus from which faecal bacteria (especially E. coli, Streptococci, Staphylococci, but also, Proteus and Klebsiella) can easily go into the urethra and bladder causing infection and inflammation.

The acute cystitis is the second most common infection (after respiratory infections). The treatment of this disease, affecting  hundreds of thousands of women in Italy every year both in its acute than in chronic recurring form is very difficult and very frustratingto manage for the urologist the gynaecologist or the GP.

In fact, simirarly to prostatis, if acute cystitis is usually easily eradicablein its first manifestation, however  the same can not be said of chronic recurrent cystitis or other cystitis (i.e. interstitial cystitis  and allodynie). Cystitis, word thatincludes different pathological situations, from an etiological point of view can be divided into:

Bacterial cystitis :

  • UTIs (=Urinary Tract infection ‘s)i.e acute bacterial cystitis (including the so-called honeymoon cystitis).
  • RUTI (=Recurrent UTI) i.e. chronic and recurrent bacteril cystitias

Non-bacterial cystitis:

  • by parasites
  • by yests
  • by physical agents (example post irradiation)
  • by chemicals
  • by vascular damage
  • by endocrine alterations

Cystitis with uncertain etiology:

  • Interstitial Cystitis
  • Urethral syndrome from pudendal Neuropathy (including the allodynia, the vestibulepathy and fibromyalgia)
  • Overactive bladder, which it can be manifested as both a symptom of previous pathologies and as a bladder pathology in itself.


The most common bacterial cystitis, i.e. without the dreaded and fortunately infrequent renal complications (pielonephritis) can be divided, (according to the patient’s clinical situation), into two groups:

  • 1° group: (UTIs) acute bacterial cystitis in Premenopausal and not during pregnancy
  • 2° group: acute bacterial cystitis in pregnancy

1° group: acute bacterial Cystitis (UTIs)

Normally the aetiologic agent, as already mentioned, is an Enterobactercoming from the rectal ampulla. There are three ways of propagation and these are:

1) or for direct transport (the most common) from the anal region to the vagina and the urethra,

2)or through the walls, from rectal ampulla directly into the bladder

3)or due to haematogenous spread (the rarest way) that is considered to be the cause of a small number of bacteria such as Staphylococcus aureus, Candida, Salmonella and Mycobacterium tuberculosis.

– The” honeymoon cystitis” is the typical example of the firstcase of transmission where enterorectalbacteriaoftenphysiologically presentin the female perineum, aretransportedinto the vaginaandthen into the urethra.

– Alterations ofthe stools (constipationordiarrhea)areoften the cause of the secondmode of transmission.

2° group: acute bacterial Cystitis during pregnancy.

In all these cases the most common infectious bacteria is Escherichia Coli, followed by Enterococcus,Klebsiella and Proteus.This type of cystitis is common during pregnancy and is usually the evolution of untreated asymptomatic bacteriuriaduring the pre pregnancy. Most women have this kind of asymptomatic bacteriuria, but only 20-40% develop acute pathology in pregnancy.


Usually to cure the disease it is enough totake the appropriateantibiotic (for usually not less than 10 days). As aforementioned, this kind of cystitis is definitely the most common form and also the easiest to treat.

However, it is essential to use the proper antibiotic!

What does it mean?

It means the disease will not be easily cured throughself administration of random antibiotics (perhaps one found at home or one what has workedon a friend in similar situations. A typical auto medication drug is thefosfomycin. This antibiotic, very effectiveas bactericide for some bacterial strains, is not appropriate for cystitis since it acts only from bacteriostatic or temporarily inhibits bacterial replication. It does relieve cystitis symptoms for a short period of time, however most times this is at the cost of dangerous relapses. Generally, it is shown that in these conditions the mono administration therapies are usually poorly effective.

So what is the correct behavior?

The antibiotic to be administered is the one prescribed by your PG after a urine culture with antibiogram.

So, what should you do if the acute cystitis typically burst during the weekends or overnight?

Collect a sample of urine in a sterile test tube (this can be found in any pharmacy or by boiling a glass container for 10 minutes) and bringit as soon as possible to the laboratory for culture tests (please keep the urine sample in the fridge until delivery!). Soon after put aside these urine, you can start with a self administered life-saving therapy, but then, at soon you obtained the bacteriological results, you should continue with the appropriate antibiotic, which is usually a quinolone antibiotic (Ciprofloxacin, Levofloxacin, Norfloxacin or the most modern Prulifloxacin).

During pregnancy the treatment of cystitis, (taking into account all previous recommendations), usually takes advantage of the use of third-generation cephalosporins, while are absolutely to be avoided in the first trimesterthe tetracyclines or quinolone antibiotics. In addition, to prevent recurrences, it could be helpful a prophylaxis with small doses of Cephalexin (125-250 mg) or nitrofurantoin (50 mg)

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