What is considered the first-line treatment for complicated cystitis?

The first-line treatment for complicated cystitis is often a course of antibiotics that covers the most common uropathogens, particularly Escherichia coli, while also addressing concerns about resistance in the community. In this context, a 7-day course of Bactrim (trimethoprim-sulfamethoxazole) is an effective option due to its broad-spectrum activity against the key pathogens involved in urinary tract infections (UTIs).

Bactrim works by inhibiting bacterial DNA synthesis through the blockade of folic acid synthesis, which is essential for bacterial growth and replication. It has been a preferred option for uncomplicated UTIs but can also be used in complicated cases, particularly if local resistance patterns are known to be low. While nitrofurantoin is effective for uncomplicated cystitis, its use is limited in complicated cystitis due to its poorer efficacy against pyelonephritis and its shorter treatment course which is usually reserved for uncomplicated cases. Comprehensive treatment for complicated cystitis often necessitates longer courses or different medications that can adequately address potential resistance and more severe infections.

The other options mentioned do not align with current recommendations for treating complicated cystitis. Azithromycin is primarily used for respiratory infections and sexually transmitted infections rather than UTIs.