Uncomplicated Cystitis
(healthy nonpregnant women, urethritis, cystitis)

*** yo M/F with PMH of *** , presenting with
 *** days constant/intermitent, progressively worsening/improving

  • CC: Dysuria, urinary frequency, urgency, suprapubic discomfort ± hematuria

  • PP: Dysuria, frequency, urgency, suprapubic pain, foul-smelling/cloudy urine, mild hematuria

  • PN: No fever, chills, flank pain, nausea/vomiting, CVA tenderness, vaginal discharge, pelvic pain, AMS, inability to tolerate PO

  • pertinent SHx: tobacco, EtOH, drug use Sexual activity, recent intercourse/new partner, hygiene habits

  • risk factors: Female sex, prior UTIs, sexual activity, spermicide use, post-menopausal state, dehydration, recent antibiotics

  • initial DATA: Vitals stable, afebrile UA: leukocyte esterase (+), nitrites (+/-), pyuria, bacteriuria CBC/BMP unremarkable in uncomplicated disease

  • pending DATA: Urine culture + susceptibilities (if obtained)

  • previous Micro:

  • MEDS: Home meds including recent antibiotics, SGLT2 inhibitors

  • COURSE:

Plan:

  • Start empiric antibiotics:

    • Nitrofurantoin 100 mg BID x5 days

    • or TMP-SMX DS BID x3 days (if low resistance/no allergy

    • CTX 1g if NPO 3-5 days -> then swith to above to finish 5 days course

  • Encourage PO hydration

  • Follow UA and urine culture/susceptibilities

  • Acetaminophen PRN pain/fever

  • Monitor for worsening symptoms including fever, flank pain, AMS, inability to tolerate PO

  • Avoid unnecessary Foley catheterization

  • Escalate workup/imaging if persistent symptoms, become septic or concern for pyelonephritis/obstruction

Quick Classification

Uncomplicated Cystitis

  • Healthy nonpregnant female with isolated lower urinary tract symptoms

Complicated Cystitis

  • Male sex, pregnancy, DM, CKD, immunocompromised state, catheter/instrumentation, obstruction, recurrent UTI

Pyelonephritis

  • Fever, chills, flank pain, CVA tenderness, nausea/vomiting, systemic illness/sepsis sign

Urinalysis (UA) – what the numbers mean

  • WBCs (pyuria):

    • Normal: 0–5 /HPF

    • >10 /HPF → infection likely

  • RBCs:

    • Normal: 0–3 /HPF

    • ↑ → stones, infection, trauma

  • Leukocyte esterase (LE):

    • Reported as negative / trace / small / moderate / large

    • Moderate–large = significant WBCs

  • Nitrites:

    • Positive = gram-negative bacteria (e.g., E. coli)

    • Negative doesn’t rule out infection

  • Bacteria:

    • Few / moderate / many

    • Moderate–many = infection more likely

Urine culture – colony count (CFU)

  • ≥100,000 CFU/mL (10⁵) → definite infection

  • 10,000–100,000 (10⁴–10⁵) → possible (use clinical context)

  • <10,000 → usually contamination