Less workup, longer treatment, but no clinical benefit observed in women with diabetes and acute cystitis

Aims: There is a lack of evidence on the optimal approach for treating acute cystitis in women with diabetes. We performed an outpatient database study to compare management of women with and without diabetes and to assess the effect of treatment duration on early and late recurrence.

Methods: We used the EPIC Clarity database (electronic medical record system) to identify all female patients aged ≥18years with acute cystitis in two family medicine clinics and a urology department. An index case was defined as the first cystitis episode during the study period (2011-2014) with follow-up data of at least 12months. Recurrence was defined as a Urinary Tract Infection (UTI) episode, plus a new prescription for an antibiotic, between 6 and 29days (early), or between 30days and 12months (late).

Results: We included 2327 visits for cystitis representing 1845 unique patients. Women with diabetes and acute cystitis were less likely to receive urinary tests to work up cystitis, and received significantly longer treatment courses of antibiotics. There was a higher risk of early recurrence in women with treatment duration >5days (odds ratio 2.17, 95% confidence interval 1.07-4.41) in multivariate analyses. Longer treatment was not associated with late UTI recurrence. Presence of diabetes, and Charlson comorbidity score were independent determinants of late recurrence.

Conclusions: Longer treatment of cystitis was not associated with lower recurrence rates. This calls into question whether many episodes of diabetic cystitis may be managed with a short course of antibiotics, as for uncomplicated disease.