Antibiotics are very effective

Antibiotics can quickly relieve the symptoms of cystitis and clear up the infection by killing the bacteria. This was proven in studies where one group of people took antibiotics and another group used a placebo (fake drug). The studies showed that people who took antibiotics felt better a lot sooner. The pain and burning went away very quickly – usually within 1 to 3 days. After one week, the symptoms had cleared up in about

• 26 out of 100 women who took a placebo and
• 60 out of 100 women who took antibiotics.

Some women had side effects from taking antibiotics. These included gastrointestinal (stomach and bowel) problems such as nausea and diarrhea, as well as headaches, rashes and itching.

Can you make do without antibiotics?

In milder cases, yes – but it's ultimately a personal decision. If you would like to get rid of the symptoms as quickly as possible, then you can take antibiotics. If you can cope well with the symptoms and don't necessarily want to take antibiotics, then you don't have to take them.

Even without antibiotics, uncomplicated cystitis goes away in about 30 to 50 out of 100 women within one week. So women who have uncomplicated cystitis won't risk anything by not taking antibiotics at first because this isn't expected to have any disadvantages. But women who have a complicated case of cystitis need to take antibiotics because the infection could then spread to the kidneys, for instance. You can talk to your doctor about whether it would make sense for you to take antibiotics.

The various antibiotics are equally effective

Several studies compared the effectiveness of the various antibiotics for the treatment of cystitis. The researchers found that all of the drugs they looked at relieved the symptoms equally well. The most suitable medication will depend on various factors, including the following:

• Are there any reasons why you can't use a particular antibiotic, for instance because you're allergic to it, can't tolerate it, or are pregnant?
• Do you have a greater risk of complications? Do you have other medical conditions or a urinary catheter?
• Are some antibiotics more likely to have certain side effects than others?
• Are some antibiotics more likely to kill the specific type of bacteria causing the infection?

Some bacteria are "resistant," meaning that they don't respond to certain antibiotics, so the antibiotics don't work. Bacteria can become resistant if antibiotics are used too often.

How long should you take the antibiotics for?

Usually, a single dose of antibiotics with a special drug is enough to relieve the symptoms. Alternatively, there are antibiotics that are taken for 3, 5 or 7 days.

The studies found the following: Treatment over 1 to 3 days was enough to relieve the symptoms in most women who had uncomplicated cystitis. Taking antibiotics for longer didn't improve symptom relief but it did lead to more side effects, such as stomach and bowel problems or rashes.

When someone has cystitis, bacteria can be detected in their urine. After a five-day course of antibiotics, the urine was bacteria-free in almost all the women. After a three-day course of antibiotics, bacteria could still be found in some women's urine. But this didn't result in more women developing cystitis again.

Sources

• Carey MR, Vaughn VM, Mann J et al. Is Non-Steroidal Anti-Inflammatory Therapy Non-Inferior to Antibiotic Therapy in Uncomplicated Urinary Tract Infections: a Systematic Review. J Gen Intern Med 2020; 35(6): 1821-1829. [PMC free article: PMC7280390] [PubMed: 32270403]
• Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Brennen beim Wasserlassen. S3-Leitlinie und Anwenderversion der S3-Leitlinie Harnwegsinfektionen. AWMF-Registernr.: 053-001. 2018.
• Falagas ME, Kotsantis IK, Vouloumanou EK et al. Antibiotics versus placebo in the treatment of women with uncomplicated cystitis: a meta-analysis of randomized controlled trials. J Infect 2009; 58(2): 91-102. [PubMed: 19195714]
• Jent P, Berger J, Kuhn A et al. Antibiotics for Preventing Recurrent Urinary Tract Infection: Systematic Review and Meta-analysis. Open Forum Infect Dis 2022; 9(7): ofac327. [PMC free article: PMC9310516] [PubMed: 35899289]
• Milo G, Katchman E, Paul M et al. Duration of antibacterial treatment for uncomplicated urinary tract infection in women. Cochrane Database Syst Rev 2005; (2): CD004682. [PubMed: 15846726]
• Ong Lopez AM, Tan CJ, Yabon AS et al. Symptomatic treatment (using NSAIDS) versus antibiotics in uncomplicated lower urinary tract infection: a meta-analysis and systematic review of randomized controlled trials. BMC Infect Dis 2021; 21(1): 619. [PMC free article: PMC8243445] [PubMed: 34187385]
• Zalmanovici Trestioreanu A, Green H, Paul M et al. Antimicrobial agents for treating uncomplicated urinary tract infection in women. Cochrane Database Syst Rev 2010; (10): CD007182. [PubMed: 20927755]

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

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