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 premenopausal women than postmenopausal 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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