• Review the diagnosis.
• Culture the urine to confirm infection and exclude other causes.
• Refer urgently if urological cancer is suspected.
• Review the woman's medical and surgical history to assess risk factors for recurrent cystitis such as stones, papillary necrosis, and vesicoureteric reflux — this assessment may require imaging and urological referral.
• Relieve symptoms with paracetamol or ibuprofen.
• If symptoms are moderate or severe, offer an antibiotic immediately.
• If symptoms are mild, suggest delaying antibiotic treatment until culture results are available to guide choice of antibiotic.
• Advise on lifestyle measures such as high-strength cranberry capsules to reduce the risk of recurrent episodes.
• If troublesome cystitis recurs frequently:
• Consider offering a prescription for a 'stand-by' antibiotic to be used for future episodes.
• Consider preventive treatments.
• Refer or seek specialist advice if these measures are not successful.

Confirming urinary tract infection and excluding other causes

• The recommendation to confirm infection with urine culture, and exclude other causes, is pragmatic.
• The recommendation to refer urgently if cancer is suspected is based on guidelines from the National Institute for Health and Clinical Excellence [NICE, 2005b].

Treatments

• The basis for recommending symptomatic relief with paracetamol or ibuprofen is discussed in Managing suspected cystitis.
• The basis for offering empirical antibiotic treatment if symptoms are moderate or severe, or delaying treatment if symptoms are mild, is discussed in Managing suspected cystitis.
• The recommendation to consider 'stand-by' antibiotics is based on expert opinion [Harris et al, 2008].

Lifestyle measures and preventive treatment

• The basis for lifestyle measures and prophylactic treatments is discussed in the sections on Lifestyle measures and Preventive treatments.

Referral

• The basis for the recommendation to refer the woman if prophylactic measures are unsuccessful is pragmatic.