Review of Evidence Paper Practice and Patient Outcome Improvements of Prescribing First-line Antibiotics for Acute Uncomplicated Cystitis

Abstract Background: In 2017, the Centers for Disease Control and Prevention (CDC) published guidelines for treating acute uncomplicated cystitis (AUC) with nitrofurantoin (NTF), sulfamethoxazole-trimethoprim (SMX-TMP), or fosfomycin (FM) as appropriate first-line agents. Objective: This paper aims to evaluate whether provider adherence to prescribing NTF, SMX-TMP, or FM has improved since the 2017 CDC guidelines were released, and to examine outcomes relative to use of prescribing guidelines in the treatment of AUC in non-pregnant women. Methods: A literature review was conducted. The Cochrane Risk of Bias Tool was used to assess publication bias. The John Hopkins Research Evidence Appraisal Tool was used to grade the articles. The design, study sample, and major findings of each article were identified for their utility in the review of evidence. Results: The literature searches in the PubMed and Cochrane databases resulted in 56 published studies. After application of exclusion criteria, 11 peer-reviewed articles were ultimately included in this review. Limitations: Publications were still limited since the CDC released a review in 2017. Four of the studies included in this paper were retrospective. Bacterial and symptom resolutions were assessed between 9 and 28 days post-treatment at the most. Conclusion: The review showed prescribers’ increasing efforts to adhering to antibiotic prescription guidelines in the treatment of AUC, such as the 2017 CDC guidelines. The trials, systematic reviews, and meta-analyses presented strong evidence that FM, NTF, and SMX-TMP are equally efficacious and cost-effective in the treatment of AUC in non-pregnant women without concern for antibiotic resistance