Cystitis

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

About cystitis

Repeated cystitis, also known as water infections or urinary tract infections (UTI), can be uncomfortable and troublesome. Some women are prone to repeated episodes of cystitis. Men rarely suffer from cystitis, but when they do it tends to be more serious. The treatment offered here is NOT for men, only for women who are prone to repeated uncomplicated water infections.

Antibiotics for cystitis from Dr Fox service

Dr Fox supplies only standby antibiotics, either trimethoprim or nitrofurantoin, to keep in reserve to take if an infection develops. Standby antibiotic treatment is only for those women who are prone to cystitis and have already been diagnosed with it in the past. You should only use this treatment if you are confident you recognise the symptoms when you get them.

How to choose whether to order trimethoprim or nitrofurantoin is discussed below. A short questionnaire must be completed after choosing the required antibiotic. This ensures the treatment is correct for you and that you are aware of how to use it.

This postal service is not for the treatment of cystitis that has already started. If cystitis symptoms have already started contact your GP surgery, out-of-hours service, a local pharmacy, or telephone NHS 111 for advice. This will guarantee there is no delay in starting treatment.

Patients ordering antibiotics from us are required to provide their GP details. We will inform your surgery each time treatment is supplied. This allows GPs to monitor overall treatment.

Simple uncomplicated cystitis

Simple cystitis is the term used to describe an infection in the urine which is causing mild to moderate symptoms, where the infection has not spread to the kidneys, and is not causing severe generalised symptoms. Self-treatment with standby antibiotics is usually effective for simple cystitis. Symptoms usually improve within 24 hours. Symptoms of simple cystitis include:

• Burning and soreness when passing water (doctors call this dysuria)
• A need to pass water frequently, sometimes many times in an hour
• A need to run to the toilet quickly and and not being able to hold urine for longer periods
• The urine may be brown or murky and may smell strong
• People with cystitis often feel uncomfortable and unwell, and are sometimes slightly feverish

Severe or complicated cystitis

Women who have severe urine infections, a past history or serious urinary infection, or worsening symptoms once they have started treatment, should consult their regular doctor straight away. They should not self-treat, even with antibiotics, unless they are under the supervision of their regular doctor. This also applies to women who are pregnant, or have kidney or bladder abnormalities, stones, or reduced kidney function.

Severe symptoms arise when infection moves up from the bladder to the kidneys or when infection affects the whole body. Infection of the kidneys is known as pyelonephritis and requires urgent medical attention and sometimes hospital treatment.

Any of the following symptoms may indicate serious pyelonephritis or other serious infection:

• Back pain (indication of possible infection in the kidney)
• Fever (high temperature, flushing, shivering, feeling hot and cold)
• Nausea and sickness and loss of appetite
• Generalised aching and flu-like feeling and confusion

All the above symptoms suggest something more serious than a simple cystitis and the need to seek medical advice straight away.

Prevention and self-treatment without antibiotics

Sometime the frequency of episodes of cystitis infections can be reduced by wearing natural fibre rather than synthetics next to the skin. Drinking plenty each day also helps to keep the bladder flushed and can help to reduce infections. Passing water after intercourse can help for women who tend to get infections after intercourse. These simple measures may be helpful in preventing infection, although often they are not.

Sometimes cystitis will go by itself in a few days, without antibiotic treatment. It helps to drink plenty (2-3 litres or 4-5 pints a day) and over the counter preparations from pharmacies, such as cranberry tablets but not juice, which change the acidity of the urine can also be useful. If symptoms are mild, self-treatment and wait-and-see for a few days may be the best approach. If symptoms are severe or worsening antibiotics are usually preferred. Women who have repeated infections will usually know if their symptoms are likely to stop on their own.

Recurring infection

Doctors often cannot find out why a woman is getting repeated episodes of cystitis. When a woman first starts having these infections tests are sometimes carried out. These tests are usually normal.

In some women cystitis is associated with recent intercourse or can be associated with stress. However, most water infections seem to start for no particular reason. If a woman has repeated episodes of cystitis, and the pattern of infection and symptoms are not changing, doctors usually just treat with antibiotics as each infection arises.

Choosing between trimethoprim or nitrofurantoin

Trimethoprim and nitrofurantoin are both antibiotics. They are usually both effective in treating cystitis, although there is increasing antibiotic resistance to trimethoprim. Nitrofurantoin is now (2017) the most widely prescribed first line treatment for cystitis. A first-line treatment is the one that is usually recommended and prescribed first by doctors. Up to 30% of bacteria which cause water infections are currently resistant to trimethoprim. The amount of bacterial resistance to particular antibiotics varies from one part of the country to another.

Women who get repeated water infections may well already know which antibiotic tends to be best for them. They may find that either nitrofurantoin or trimethoprim is not suitable for them, or has side-effects. Nitrofurantoin is a good first choice, because in general there is less bacterial resistance, but many infections respond well to trimethoprim. Women who have been taken trimethoprim within the previous year should consider taking nitrofurantoin. Your GP should be able to advise if you are not sure which antibiotic to obtain. Remember, if you already have an infection contact your surgery or out-of-hours service.

For more information about each antibiotic see the nitrofurantoin page and the trimethoprim page. There are also links below to the manufacturer's leaflets supplied with these medicines. Antibiotic for cystitis is taken once every 12 hours for 3 days. Please note that the manufacturer's Patient Information Leaflet for nitrofurantoin states 7 days - a standard course of cystitis treatment has now been reduced to 3 days.

Other antibiotics commonly used to treat cystitis include ciprofloxacin, norfloxacin, ofloxacin, and co-amoxiclav (Augmentin). These antibiotics tend to be reserved for more serious infections or special situations and are not available from Dr Fox.

Response to treatment

Simple cystitis will improve greatly within 24 hours of starting antibiotics. If symptoms are not improving in the first 24 hours, or have not gone completely at the end of 3 days, medical advice is needed. A urine sample may need to be sent for laboratory testing. If symptoms worsen rather than improve medical advice is needed straightaway.

Antibiotic guardianship

To combat antibiotic resistance please:

• Only use antibiotics when needed
• Never share antibiotics
• Always complete course as instructed
• Take unused medicine to local pharmacy for disposal

Dr Fox supplies treatment on prescription – you are required to answer a short medical questionnaire before your order can be completed.

Authored 18 February 2010 by Dr Tony Steele
Last updated 15 October 2021

Reviewed by Dr B. Babor, Dr A. Wood, Dr P. Hunt
Last reviewed 01 March 2019

1. Medical questions
2. Choose treatment
3. Complete order