Cystitis (chronic)

Summary: Urological referral may be necessary

Advice: Urological referral may be necessary if simple measures fail to resolve the problem.
Refer To: Any adult urologist (by generic referral)


Clinical information

Low-dose, prophylactic antibiotics (Nitrofurantoin, Trimethoprim, Norfloxacin or Cephalexin) are the mainstay of treatment for recurrent urinary infections . Plain abdominal X-ray & ultrasound should be considered before treatment. If there is a significant residual urine after voiding on ultrasound, consider referral for cystoscopy and dilatation of the bladder neck; this is most commonly seen in post-menopausal women.

Please note: Trimethoprim should be avoided in the first trimester of pregnancy; Nitrofurantoin should be avoided at term (because of the risk of haemolysis) or if the patient is G-6PD deficient.

Self-help measures (see information sheet below) should, in addition, be instituted for women with recurrent cystitis. Post-coital antibiotics are as effective as low-dose prophylaxis in women whose UTIs are initiated by sexual intercourse.

All men and children with recurrent UTIs should be referred for further investigation. It is helpful to arrange a plain abdominal X-ray & ultrasound prior to the appointment.

When bladder pain is prominent, especially in women, consider a diagnosis of interstitial cystitis and refer for urological advice.

Referral should considered for the following groups:

  • women with recurrent cystitis despite conservative measures
  • all children
  • all men
  • pregnant women
  • patients with associated episodes of pyelonephritis
  • diabetics
  • patients with known urinary tract abnormalities
  • patients with known urinary calculi
  • patients with known urinary tract malignancy
  • patients with disproportionate haematuria

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Other important information

  1. It is essential for us to receive all MSU results to help in subsequent management decisions
  2. Recurrent cystitis may also be a presenting feature of bladder cancer, especially in older patients with haematuria and urinary infection
  3. Urine dipstick tests have high false-negative rates and cannot be relied upon to confirm or refute the presence of infection
  4. Asymptomatic bacteriuria is seen in 25% of women & 10% of men >65 years and, except in pregnancy, is not associated with increased morbidity per se
  5. In the presence of a catheter, antibiotics will not eradicate bacteria and there is no indication for treatment unless the patients is systemically unwell

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Special information

[This page contains guidelines and advice from professional bodies, together with information about the prescription of drugs. Since all NHS hospitals have local arrangements with their Primary Care Trusts (PCTs) about which medicines can be used, some drugs mentioned cannot be prescribed by local hospitals.

Treatment of patients will be planned with the Consultant responsible for care, taking into account those drugs which are or are not available at the local hospital and what is appropriate for optimum patient care.

Healthcare professionals are advised to check prescribing arrangements with their local hospital or PCT.

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