›Analgesia strategy
›Acetaminophen 1000 mg PO every 6 to 8 hours PRN
›Maximum 3000 mg per 24 hours for many adults
›Lower maximum with liver disease
›Ibuprofen 400 mg PO every 6 to 8 hours PRN
›Avoid with AKI risk
›Avoid with GI bleed risk
›Urinary analgesic option
›Phenazopyridine 200 mg PO three times daily
›Maximum 2 days with antibiotic initiation
›Orange urine discoloration
›Hydration
›Oral fluids as tolerated
›Avoid forced hydration causing discomfort
›Reassure urinary frequency may persist early
Antibiotics for uncomplicated cystitis
›First line regimens for nonpregnant female
›Nitrofurantoin monohydrate macrocrystals 100 mg PO twice daily for 5 days
›Avoid if suspected pyelonephritis
›Avoid if eGFR very low per local guidance
›TMP SMX DS 160 mg 800 mg PO twice daily for 3 days
›Use when local E coli resistance under 20 percent
›Avoid with sulfa allergy
›Fosfomycin trometamol 3 g PO single dose
›Lower efficacy than nitrofurantoin in some studies
›Useful for adherence barriers
›Alternative regimens when first line not suitable
›Amoxicillin clavulanate 875 mg 125 mg PO twice daily for 5 to 7 days
›Higher recurrence than first line agents
›GI adverse effects common
›Cephalexin 500 mg PO four times daily for 5 to 7 days
›Consider for pregnancy compatible option
›Local susceptibility dependent
›Cefpodoxime 100 mg PO twice daily for 5 days
›Alternative beta lactam
›Higher failure than TMP SMX in some settings
›Fluoroquinolone stewardship
›Ciprofloxacin 250 mg PO twice daily for 3 days
›Reserve for intolerance to preferred agents
›Avoid when safer options available
›Levofloxacin 250 mg PO daily for 3 days
›Similar stewardship constraints
›Tendinopathy and QT risk
Treatment failure and escalation
›Persistent symptoms beyond 48 to 72 hours
›Culture review
›Switch to susceptible agent
›Confirm organism
›Reassessment for alternative diagnosis
›Vaginitis or STI
›Stone or obstruction
›Imaging threshold lower with systemic features
›Renal ultrasound
›CT if high concern
›Suspected early pyelonephritis
›Oral regimen selection
›Fluoroquinolone per local guidance
›Beta lactam less preferred without initial IV dose
›Initial parenteral option when resistance concerns
›Ceftriaxone 1 g IV once
›Gentamicin 5 mg/kg IV once
›Evidence framing
›Short course therapy for uncomplicated cystitis is guideline supported
›Class I recommendation based on infectious diseases guideline consensus
›Stewardship priority to minimize collateral damage