Information for the public

Cystitis: do I need antibiotics?

Cystitis is inflammation or irritation of the bladder, which may be caused by a bacterial infection (a lower urinary tract infection, or lower UTI). Symptoms include needing to pass urine more often or urgently, pain or burning when urinating, and cloudy or strong-smelling urine. Other symptoms are feeling tired or weak and pain in the lower abdomen (tummy area). Cystitis may clear up on its own after a few days but some people need antibiotics.

Using antibiotics when they are not needed means they may not work as well in the future. This is a serious health risk so NICE has written advice about when to offer antibiotics for some common conditions, including cystitis.

Pregnant women, men, and children and young people aged under 16 with cystitis should be offered antibiotics straightaway.

Women who are not pregnant may not be offered antibiotics straightaway. Instead you may be offered a ‘back-up’ antibiotic prescription. You can use this to get an antibiotic if you don’t start to feel better within 2 days, or start to feel worse.

You can also help your symptoms in other ways, for example by taking a painkiller like paracetamol, or ibuprofen if this is suitable for you. You may want to try cranberry drinks or products that lower the acidity of your urine (called urine alkalising products), but NICE found no research on using these to treat urinary tract infection.

Starting antibiotics

If you’re offered antibiotics your doctor should explain that they can cause side effects, such as diarrhoea and nausea (feeling sick).

You should see your doctor if you don’t start to feel better 2 days after you start antibiotics, or sooner if you start to feel worse. Your doctor may refer you to hospital if you have signs of a serious illness such as sepsis.

Where can I find out more?

Decisions about treatment and care are best when they are made together. Your health professionals should give you clear information, talk with you about your options and listen carefully to your views and concerns. NICE has developed information (a decision aid) to help women who are not pregnant to make decisions about treatments for cystitis.

The NHS website has more information about:

We have also written information on why antibiotics should be used wisely.

We wrote this guideline with health professionals and members of the public. All the recommendations are based on the best research available.

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