Table 2.

Antimicrobial management of acute uncomplicated cystitis ^a.

Antimicrobial	Dosing and Duration	Efficacy
First-Line Agents
Nitrofurantoin monohydrate/macrocrystal b	100 mg twice daily × 5 days (with meals)	Clinical efficacy of 5–7 day regimen: 93% (84%–95%) 3–day regimen appears less effective vs. longer regimens Minimal in vitro resistance
Trimethoprim-sulfamethoxazole c	160/800 mg twice-daily × 3 days	Clinical efficacy of 3-day TMP-SMX regimen: 93% (90%–100%) Avoid if resistance >20% or exposure in prior 3–6 months
Fosfomycin trometamol	3 g sachet in a single dose	Appears to be less effective vs. TMP-SMX or fluoroquinolones Minimal in vitro resistance, but most labs do not test
Pivmecillinam	400 mg twice daily × 3–7 days	Clinical efficacy of 3–7 day regimens: 73% (55%–82%) Minimal in vitro resistance Unavailable in some countries
Second-Line Agents
Fluoroquinolone: Ciprofloxacin c Levofloxacin c	250 mg twice daily × 3 days 250 mg or 500 mg once daily × 3 days	Clinical efficacy 90% (85%–98%) High prevalence of in vitro resistance in some regions of the world
β-lactamb:(e.g., amoxicillin-clavulanate, cefdinir, cefaclor, and cefpodoxime-proxetil)	3–7 days	Clinical efficacy of 3–5 day regimens: 89% (79%–98%) Less effective thanTMP-SMX and fluoroquinolones Prevalence of E. coli resistance is variable

Adapted from ref. [2]. ^a Efficacy data and antimicrobial recommendations based on IDSA guidelines [13]; ^b Pregnancy category B—no clear risk to fetus based on animal and/or human studies; ^c Pregnancy category C—animal studies have shown an adverse effect on the fetus; use only if potential benefit justifies the potential risk to the fetus.