Cystitis, a type of urinary tract infection (UTI), refers to inflammation of the bladder mucosa caused by bacterial infection. (UTI also includes pyelonephritis, but this document will focus on cystitis only.) Escherichia coli is the cause in 80% of cases; other possible causes include klebsiella, enterobacter, proteus, pseudomonas, serratia, streptococcus faecalis, and staphylococcus. UTI is a common secondary condition of many developmental disabilities.
Note: These considerations are in addition to the normal medical care provided to an individual without urinary tract infection. All recommendations can be addressed through clinical examination by the primary care provider, unless otherwise noted; however, a good nursing consultation to give individualized patient training to a female with recurrent bladder infections may be helpful.
Cystitis heals in almost all patients within 2-3 days of starting medical treatment. However, these treatments may not address the underlying mechanical cause. To prevent symptoms from recurring, it is important to address the underlying cause in addition to symptoms of pain or discomfort.
Note: Patients with indwelling urinary catheters are likely to be colonized with bacteria rather than infected. As a result, patients with indwelling catheters should demonstrate symptoms of infection (pain, fever, sepsis, etc.) before treatment is warranted. In these individuals, removal of the catheter and intermittent catherization during antibiotic therapy may be necessary to eliminate the infection.
Classic symptoms may not require urine culture for diagnosis, but it is required to identify the causative agent and treatment sensitivity. Perform the following test(s) if the patient is an infant or child, if it is a repeat episode, if the patient is pregnant, if symptoms are not classic, or if there is risk for complicated infection.
Note: Obtain post-treatment urine culture to document eradication of infection.
First UTI: Antibiotics for 3 or more days (trimethoprim-sulfamethoxazole (TMP-SMX) or fluoroquinolone)
Recurrent/chronic UTI: 10-14 day treatment with antibiotic (fluoroquinolone, TMP-SMX, cephalosporin, or other based on culture/sensitivity results)
Pregnant patients: 10-14 day or longer treatment with pregnancy-safe antibiotic (cephalosporin, amoxicillin, or other based on culture/sensitivity results)
Postcoital: postcoital single dose of TMP-SMX or cephalexin for sexually active females
Hooton, T.M. et al. (1996). A Prospective Study of Risk Factors for Symptomatic Urinary Tract Infection in Young Women. New England Journal of Medicine 335(7), 468-474.
Hutton J. et al. (1994). Management of Bacterial Urinary Tract Infections in Adults. Annals of Pharm, 28(11), 1264-1272.
Liptak, G., (1996). Neural Tube Defects. (1996). In ML Batshaw (Ed.), Children with Disabilities (4th ed., pp. 529-552). Baltimore: Paul H. Brookes.
Stamm, W.E Hooton, T.M. (1993). Management of Urinary Tract Infections in Adults. New England Journal of Medicine, 329(18) 1328-1334.
Fields, S.A. (1999). Urinary Tract Infection in Males. In M.R. Dambro (Ed.), Griffith’s 5 Minute Clinical Consult (pp. 1126-1127.) Baltimore: Lippincott Williams & Wilkins.
Smith Consultant Group and McGowan Consultants. (1998). Urine Elimination. In M.L. Snyder (Ed.), Health and Wellness Reference Guide (pp. 145-146). Neri Productions, State of Tennessee Commission on Compliance.
Starrett, A.L. (1991). In: Developmental Disabilities in Infancy and Childhood. (Eds.) A.J. Capute, & P.J. Accardo. Baltimore: Paul H. Brookes., pp. 184-185.
Weiss, Barry D. MD. (1999). Urinary Tract Infection in Females. In M.R. Dambro (Ed.), Griffith’s 5 Minute Clinical Consult (pp. 1124-1125). Baltimore: Lippincott Williams & Wilkins.
American College of Obstetricians and Gynecologists,
American Foundation for Urologic Disease, 410-468-1800,
American Urological Assocation,
California Department of Developmental Services, 916-654-1690,
California Regional Centers, 916-654-1958,
National Kidney Foundation,
Society of Urologic Nurses and Associates,
Theodore A. Kastner, M.D., M.S.
Felice Weber Parisi, M.D., M.P.H.
Robin L. Hansen, M.D.
Funded by a grant from the California Department of Developmental Services
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This document does not provide advice regarding medical diagnosis or treatment for any individual case, and any opinions or statements contained in this document are not intended to serve as a standard of medical care. Physicians are encouraged to view the considerations presented in this document in light of evolving scientific information. This document is not intended for use by the layperson. Reproduction of this document may be done with proper credit given to California Department of Developmental Services and the Center for Health Improvement.
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