How effective are antibiotics in treating acute cystitis?
Treatment with antibiotics 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 antibiotics.
Uncomplicated cystitis is very common in women. It is caused by a bacterial infection. 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 antibiotics. Uncomplicated cystitis usually goes away without any problems.
Antibiotics are very effective
Antibiotics can quickly relieve the symptoms of cystitis and clear up the infection by killing the bacteria. This was proven in studies where one group of people took antibiotics and another group used a placebo (fake drug). The studies showed that people who took antibiotics 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 antibiotics.
Some women had side effects from taking antibiotics. 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 antibiotics. If you can cope well with the symptoms and don't necessarily want to take antibiotics, then you don't have to take them.
Even without antibiotics, 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 antibiotics at first because this isn't expected to have any disadvantages. But women who have a complicated case of cystitis need to take antibiotics because the infection could then spread to the kidneys, for instance. You can talk to your doctor about whether it would make sense for you to take antibiotics.
The various antibiotics are equally effective
Several studies compared the effectiveness of the various antibiotics 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 catheter?
- Are some antibiotics more likely to have certain side effects than others?
- Are some antibiotics more likely to kill the specific type of bacteria causing the infection?
How long should you take the antibiotics for?
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 antibiotics 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, bacteria can be detected in their urine. After a five-day course of antibiotics, the urine was bacteria-free in almost all the women. After a three-day course of antibiotics, bacteria 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.
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