Epidemiology

Acute cystitis has been reported as the most common bacterial infection and is associated with a significant number of healthcare visits every year.[3]​​​​[4]​​​[5]​ Acute cystitis is much more common in women than men.[3] Estimates for cystitis in the community are 3% to 12.6% per year for women compared to 0.5% to 3% per year for men.[3] This has classically been attributed to the shorter urethra in women. Acute uncomplicated cystitis is more common among pre-menopausal women than post-menopausal women, possibly due to greater rates of sexual activity.​[4]​​[6]

In one telephone survey of 2000 randomly sampled women >18 years, 10.8% of women had experienced a urinary tract infection (UTI) in the past 12 months, and by 24 years of age it is estimated that 33% of women will have experienced a UTI.[7] It has been estimated that 20% to 40% of women with acute cystitis will develop recurrent episodes.[8]​​

The high prevalence of acute cystitis results in high antibiotic usage, with one study across four countries reporting that antibiotics were prescribed for 88.5% of cases.[9]​ High antibiotic usage is associated with the emergence of antibiotic resistance. In one German observational study, Escherichia coli was the causative pathogen in 86% of cases of uncomplicated acute cystitis, with high resistance (>20%) to ampicillin, amoxicillin, amoxicillin/clavulanate, and trimethoprim, but low resistance to nitrofurantoin and fosfomycin.[6]​ Findings were similar in one cross-sectional study of lower UTIs across Europe, with nitrofurantoin and fosfomycin remaining highly active against E coli.[10]​ An overall trend for growing rates of antibiotic resistance has led to much concern and ongoing debate around best practice for first-line treatment of UTIs.

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