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Lack of uniformity among United States recommendations for diagnosis and management of acute, uncomplicated cystitis

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Abstract

Introduction and hypothesis

Acute, uncomplicated cystitis is one of the most common bacterial infections seen in clinical practice. Quality improvement and antibiotic stewardship efforts to optimize cystitis management rely on clinicians managing patients in a manner recommended by experts and guidelines. However, it is unclear if recent recommendations for cystitis from experts and guidelines from US medical societies that provide recommendations are well aligned.

Methods

We examined recommendations and guidelines for acute, symptomatic cystitis in women published in US medical societies’ journals from January 1, 2008, to December 31, 2016, within the fields of family medicine, obstetrics and gynecology, internal medicine, female pelvic medicine and reconstructive surgery, and infectious diseases.

Results

All recommendations endorsed the use of symptoms and urine dipstick to diagnose cystitis. Some societies did not recommend urine dipstick in patients with recurrent urinary tract infection (UTI), classic UTI symptoms, or a lack of underlying conditions or competing diagnoses. All endorsed nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin as first-line agents. Some guidelines classified fluoroquinolones as second- or third-line, while others considered them first-line treatment for UTI. Avoiding use of amoxicillin and ampicillin, antibiotic agents with high prevalence of resistance in the US, was recommended by some societies.

Conclusions

US recommendations differed in their approach to the treatment of acute, uncomplicated cystitis. Lack of uniformity likely contributes to clinical management variance for patients with UTI and hampers quality improvement and antibiotic stewardship efforts aimed at promoting optimal management. Our findings emphasize the need for more consistent recommendations for cystitis management.

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Author notes

  1. Melissa A. Markowitz and Lauren N. Wood contributed equally to this work.

Authors and Affiliations

  1. David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA

    Melissa A. Markowitz, Lauren N. Wood, Shlomo Raz, David A. Haake & Ja-Hong Kim

  2. Harbor-UCLA Medical Center, Torrance, CA, USA

    Loren G. Miller

Authors
  1. Melissa A. Markowitz
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  2. Lauren N. Wood
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  3. Shlomo Raz
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  4. Loren G. Miller
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  6. Ja-Hong Kim
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Corresponding author

Correspondence to Melissa A. Markowitz.

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Financial disclaimers

Dr. David A. Haake owns shares in MicrobeDx, Inc., and Qvella, Inc. Dr. Loren G. Miller has received grants from Achaogen, Merck, and Tetraphase.

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Markowitz, M.A., Wood, L.N., Raz, S. et al. Lack of uniformity among United States recommendations for diagnosis and management of acute, uncomplicated cystitis. Int Urogynecol J 30, 1187–1194 (2019). https://doi.org/10.1007/s00192-018-3750-z

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  • DOI: https://doi.org/10.1007/s00192-018-3750-z

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