Acute uncomplicated cystitis in young women

A. Sexually active young women have the highest risk for UTIs. Their propensity to develop UTIs is caused by a short urethra, delays in micturition, sexual activity, and the use of diaphragms and spermicides.

B. Symptoms of cystitis include dysuria, urgency, and frequency without fever or back pain. Lower tract infections are most common in women in their childbearing years. Fever is absent.

C. A microscopic bacterial count of 100 CFU/mL of urine has a high positive predictive value for cystitis in symptomatic women. Ninety percent of uncomplicated cystitis episodes are caused by Escherichia coli; 10 to 20 percent are caused by coagulase-negative Staphylococcus saprophyticus and 5 percent are caused by other Enterobacteriaceae organisms or enterococci. Up to one-third of uropathogens are resistant to ampicillin, but the majority are susceptible to trimethoprim-sulfamethoxazole (85 to 95 percent) and fluoroquinolones (95 percent).

D. Young women with acute uncomplicated cystitis should receive urinalysis (examination of spun urine) and a dipstick test for leukocyte esterase.

E. A positive leukocyte esterase test has a sensitivity of 75 to 90 percent in detecting pyuria associated with a UTI. The dipstick test for nitrite indicates bacteriuria. Enterococci, S. saprophyticus and Acinetobacter species produce false-negative results on nitrite testing.

F. Three-day antibiotic regimens offer the optimal combination of convenience, low cost and efficacy comparable to seven-day or longer regimens.

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