Acute cystitis

Case report:

A 23-year-old female will appear in practice and complains of pain during the last four days existing urination associated with urinary urgency and frequent dribbling. This was preceded by a 14-day holiday with her boyfriend. Fever she had not observed, appetite and bowel movements were normal.
Physical examination results in a completely normal physical findings, the body temperature is normal, the heart rate is 70 / min. And the blood pressure at 120 / 75mmHg. Even a knock sensitivity or tenderness in the area of the renal capsule can not be proved.

Diagnosis:

The history of the two-week vacation (increased sexual intercourse) and the typical symptoms indicate an acute infection of the urinary bladder. The immediately made urine sediment analysis shows a significant increase of leucocyturia without erythrocytes and no proteinuria. Since it is the first manifestation of an acute urinary tract infection, is dispensed with at this point to a bacteriological examination of urine for cost reasons.

Pathogenesis:

When young, sexually active women are acute urinary tract infection, usually on the ascending infection, relatively frequently. In more than 80% are detected as pathogens E. coli, Proteus mirabilis rare, Klebsiella or enterococci and Staphylococcus saprophyticus. With an empty history regarding pre-existing conditions or urogenital urological manipulations a further diagnosis is not necessary.

Therapy:

In younger women with acute uncomplicated UTI may be sufficient a single therapy, where today, however, again there is a tendency to a three-day treatment. As substances cotrimoxazole (EUSAPRIM others), trimethoprim (TMP-ratiopharm, etc.) or quinolones of group I and II, such as norfloxacin (BARAZAN), ofloxacin (Tarivid) or ciprofloxacin (Cipro) into consideration. The subjective symptoms should disappear under this therapy within 48 hours, otherwise a further diagnosis is necessary.

Addition:

The increased resistance of uropathogenic enterobacteria, especially E. coli, more difficult in recent years increasingly empirical antibiotic therapy of the very frequent acute cystitis and pyelonephritis uncomplicated. When selecting the recommended antibiotics allergic disposition of the patient, the local resistance situation and the availability and cost of each substance should be considered. In the international guidelines, a distinction is made between first-line and second-line drugs, which in addition to the clinical effectiveness in controlled studies, the undesirable effects are taken into account. Nitrofurantoin (Furadantin, etc.), cotrimoxazole (EUSAPRIM others) and fosfomycin trometamol (Monuril) are the recommended Erstlinientherapeutika that are characterized by high clinical efficacy, low impact on the body's flora and favorable cost. The specific Unvertr�glichkeits reactions of these substances should be the attending physician known, although usually a short-term therapy for only three to five days or a single dose of an overall good tolerability worry.