Three-day antibiotic course suits most women with cystitis

The standard 3-day course of antibiotic treatment for cystitis in women achieves a similar rate of symptomatic cure as prolonged therapy, although bacteriologic failure is less likely with longer-term therapy, suggests a new meta-analysis published in the American Journal of Medicine (2005; 118:1196-1207).

The analysis was based on a review of 32 randomized, controlled trials, including 9,605 patients, comparing the two approaches. Both short-term and long-term follow-up found no differences in rates of symptomatic failure between 3-day therapy and more prolonged treatment, according to the researchers, led by Eugene A. Katchman, MD, of E. Rabin Medical Center in Petah-Tiqva, Israel. But women given antibiotics for 5 days or longer were 47% more likely to be free of bacteriuria 4 to 10 weeks after treatment.

Based on these findings, the team said the 3-day therapy should still be used for most women with cystitis, but among women for whom bacteriologic eradication is essential, a 7-day course of treatment may be more appropriate.

“The decision should be taken with the patient, balancing the higher bacteriological cure rate versus the increased risk for adverse events,” the authors wrote.