How effective are antibiotics in treating acute cystitis?

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Treatment with nearly always makes the symptoms of uncomplicated cystitis go away quickly. Three days is usually enough. But uncomplicated cystitis doesn't always have to be treated with .

Uncomplicated cystitis is very common in women. It is caused by a bacterial . The main symptom is a burning pain when peeing (urinating), often accompanied by an increased urge to pee. Although these symptoms are often very unpleasant, they can be effectively treated with . Uncomplicated cystitis usually goes away without any problems.

Antibiotics are very effective

Antibiotics can quickly relieve the symptoms of cystitis and clear up the by killing the . This was proven in studies where one group of people took and another group used a placebo (fake drug). The studies showed that people who took felt better a lot sooner. The pain and burning went away very quickly – usually within 1 to 3 days. This is what was found after one week:

  • The symptoms cleared up in about 26 out of 100 women who took a placebo.
  • The symptoms cleared up in about 60 out of 100 women who took .

Some women had side effects from taking . These included gastrointestinal (stomach and bowel) problems such as nausea and diarrhea, as well as headaches, rashes and itching.

Can you make do without antibiotics?

In milder cases, yes – but it's ultimately a personal decision. If you would like to get rid of the symptoms as quickly as possible, then you can take . If you can cope well with the symptoms and don't necessarily want to take , then you don't have to take them.

Even without , uncomplicated cystitis goes away in about 30 to 50 out of 100 women within one week. So women who have uncomplicated cystitis won't risk anything by not taking at first because this isn't expected to have any disadvantages. But women who have a complicated case of cystitis need to take because the could then spread to the kidneys, for instance. You can talk to your doctor about whether it would make sense for you to take .

The various antibiotics are equally effective

Several studies compared the effectiveness of the various for the treatment of cystitis. The researchers found that all of the drugs they looked at relieved the symptoms equally well. The most suitable medication will depend on various factors, including the following:

  • Are there any reasons why you can't use a particular antibiotic, for instance because you're allergic to it, can't tolerate it, or are pregnant?
  • Do you have a greater risk of complications? Do you have other medical conditions or a urinary ?
  • Are some more likely to have certain side effects than others?
  • Are some more likely to kill the specific type of causing the ?

Some are "resistant," meaning that they don't respond to certain , so the don't work. Bacteria can become resistant if are used too often.

How long should you take the antibiotics for?

Usually, a single dose of with a special drug is enough to relieve the symptoms. Alternatively, there are that are taken for 3, 5 or 7 days.

The studies found the following: A one- to three-day treatment was enough to relieve the symptoms in most women who had uncomplicated cystitis. Taking for longer didn't improve symptom relief but it did lead to more side effects, such as stomach and bowel problems or rashes.

When someone has cystitis, can be detected in their urine. After a five-day course of , the urine was bacteria-free in almost all the women. After a three-day course of , could still be found in some women's urine. But this didn't result in more women developing cystitis again.

Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Brennen beim Wasserlassen . S3-Leitlinie und Anwenderversion der S3-Leitlinie Harnwegsinfektionen. AWMF-Registernr.: 053-001. July 2018. (DEGAM guidline no. 1).

Falagas ME, Kotsantis IK, Vouloumanou EK, Rafailidis PI. Antibiotics versus placebo in the treatment of women with uncomplicated cystitis: a meta-analysis of randomized controlled trials. J Infect 2009; 58(2): 91-102.

Milo G, Katchman E, Paul M, Christiaens T, Baerheim A, Leibovici L. Duration of antibacterial treatment for uncomplicated urinary tract infection in women. Cochrane Database Syst Rev 2005; (2): CD004682.

Zalmanovici Trestioreanu A, Green H, Paul M, Yaphe J, Leibovici L. Antimicrobial agents for treating uncomplicated urinary tract infection in women. Cochrane Database Syst Rev 2010; (10): CD007182.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on October 24, 2019
Next planned update: 2022

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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