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Last Updated: 10/23/2013  

Urinary Tract Infection

Screening
  • Screen for asymptomatic bacteriuria in pregnant women as part of routine prenatal care.

  • Do not screen non-pregnant women.

Diagnosis
  • Ask patients about signs and symptoms of UTI, and understand that the combination of dysuria, frequency, and the absence of vaginal discharge or irritation is highly predictive of UTI in women.

  • Examine for pyelonephritis in women and men and for prostatitis in men.

  • Screen patients with presumed cystitis for underlying medical or urologic conditions that may predispose them to treatment failure, infection with antibiotic-resistant organisms, or infectious complications that would affect the appropriate diagnostic work-up and course of therapy.

  • Use urinalysis either via dipstick or microscopy to help confirm the diagnosis in most women with suspected UTI. Note that some women with uncomplicated UTI based on history and physical exam do not need testing.

  • Use urine culture tests selectively in patients at risk for complications or in whom there is diagnostic uncertainty.

  • Evaluate men with cystitis for causative factors.

Therapy
  • Treat nonpregnant women with uncomplicated cystitis with a short course of oral antibiotics using TMP-SMZ, nitrofurantoin, or fosfomycin.

  • In pregnant women with cystitis, perform urine culture and susceptibility testing and treat for 3 to 7 days with an oral antimicrobial agent that is safe for use in pregnancy.

  • Perform a urine culture in nonpregnant women with complicated cystitis and treat empirically for 7 to 14 days with a fluoroquinolone agent or, if the organisms are known to be susceptible, with TMP-SMZ.

  • Consider prophylaxis for women with recurrent episodes of UTI per year with continuous or post-coital treatment.

  • Consider self-initiated therapy for women with frequent recurrent episodes of UTI not associated with coitus who are able to recognize the characteristic symptoms of UTI and who wish to avoid continuous antibiotic prophylaxis.

DOI: 10.7326/d162
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
James R. Johnson, MD received grants from Merck, Ortho-McNeil, Wyeth-Ayerst, Bayer, Proctor and Gamble. Ann Stapleton, MD, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Barbara W. Trautner, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Ann Stapleton, MD, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Dimitri Drekonja, MD, MS submitted a VA Merit Review grant to study the duration of therapy for male UTI.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, Editor.
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