What is the treatment of choice for uncomplicated cystitis?

The treatment of choice for uncomplicated cystitis, particularly in women, is either nitrofurantoin or trimethoprim-sulfamethoxazole. These antibiotics are preferred due to their effectiveness against common uropathogens like Escherichia coli, which is responsible for the majority of uncomplicated urinary tract infections (UTIs). Nitrofurantoin works by inhibiting bacterial cell wall synthesis and is specifically concentrated in the urine, making it ideal for treating cystitis. Trimethoprim-sulfamethoxazole is a combination antibiotic that disrupts bacterial folate synthesis, providing broad-spectrum coverage against the pathogens that commonly cause cystitis.

These options are generally well-tolerated and have favorable side effect profiles compared to other antibiotics, thus making them the first-line therapies. In contrast, antibiotics like ciprofloxacin are used for more complicated cases or specific scenarios due to concerns regarding the development of resistance and potential side effects. Aminoglycosides are not typically used for uncomplicated lower UTIs due to their toxicity and dosing requirements. Metronidazole is effective against anaerobic bacteria and certain protozoa, but it is not appropriate for treating uncomplicated cystitis where the pathogens are primarily aerobic organisms.