Choosing Wisely:

Don’t treat uncomplicated cystitis in women with fluoroquinolones if other oral antibiotic treatment options exist.

Rationale and Comments: Due to serious potential side effects associated with the use of fluoroquinolone antibiotics, these drugs should not be prescribed as first-line therapy for uncomplicated cystitis in women. Their use should be reserved for situations where recommended first-line antibiotic therapies, such as nitrofurantoin or sulfa-trimethoprim, are contraindicated.
Sponsoring Organizations:
  • American Urological Association
  • Sources:
  • Expert consensus
  • Disciplines:
  • Urologic
  • Infectious disease
  • References: • FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together, July 26 2016;
    • International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis (2011) 52 (5): e103-e120. DOI:;

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