Management of Chronic Cystitis Without Active Infection

Appropriate Use of Levofloxacin

The Infectious Diseases Society of America recommends that levofloxacin should be reserved for documented active infections rather than prophylactic or suppressive therapy in the absence of active infection 3, 4
For catheter-associated UTI with active infection, levofloxacin 750 mg once daily for 5 days may be considered for mild cases, but not for prophylaxis 2
The American College of Clinical Pharmacy suggests that fluoroquinolones, including levofloxacin, should be reserved for important uses other than uncomplicated cystitis due to their propensity for collateral damage (ecological adverse effects) 3, 4

The Centers for Disease Control and Prevention notes that unnecessary fluoroquinolone use contributes to increasing resistance rates, which are already concerning in many regions 4, 5
The World Health Organization reports that levofloxacin and other fluoroquinolones have significant adverse effects, including gastrointestinal disturbances in 0.5-1.8% of patients, neurologic effects in 0.5% of patients, and cutaneous reactions in 0.2-0.4% of patients 6

The European Association of Urology recommends that for recurrent UTIs requiring prophylaxis, other agents with better safety profiles should be considered first, such as trimethoprim-sulfamethoxazole (if local resistance rates are <20%) 4
The American Urological Association suggests that nitrofurantoin and beta-lactams may be considered as alternative prophylactic agents in appropriate situations 3, 4

The Infectious Diseases Society of America advises that fluoroquinolone resistance should be considered before empiric use, particularly in areas with >10% resistance rates 7
The American College of Physicians recommends that for patients with chronic cystitis symptoms without active infection, non-antimicrobial approaches should be explored first 1
The European Society of Clinical Microbiology and Infectious Diseases notes that the diagnosis of chronic cystitis without active infection should prompt investigation for other underlying causes rather than empiric antimicrobial therapy 1, 2