Suspected UTI
Dysuria, frequency, urgency, suprapubic pain
All Pathways
Internal MedicineManagement
Urinary Tract Infection Management
Urinary Tract Infection Management: Suspected UTI → Classify UTI Type → Uncomplicated Cystitis → First-Line Cystitis Treatment → Clinical Response.
Pathway Overview
14 steps
Algorithm Steps
14 total
01Start 02Decision Classify UTI Type
Cystitis vs Pyelonephritis vs Complicated
- Cystitis: dysuria, frequency, urgency (no systemic symptoms)
- Pyelonephritis: flank pain, fever, CVA tenderness
- Complicated: male, pregnant, catheter, structural abnormality
03Action Uncomplicated Cystitis
Non-pregnant woman, no complicating factors
- UA/culture optional if classic symptoms
- Empiric treatment appropriate
- Short course therapy effective
04Action First-Line Cystitis Treatment
Based on local resistance patterns
- Nitrofurantoin 100mg BID x5 days (1st line)
- TMP-SMX DS BID x3 days (if resistance <20%)
- Fosfomycin 3g single dose
- Avoid fluoroquinolones for uncomplicated
05Decision Clinical Response
Reassess at 48-72 hours
06Outcome UTI Resolved
Complete antibiotic course
- Test of cure not needed for uncomplicated
- Consider test of cure if recurrent
07Warning Not Improving
Consider resistance or complication
- Review culture results
- Imaging to rule out abscess/obstruction
- Consider resistant organism
- Urology/ID consultation
08Action Pyelonephritis
Upper tract infection
- Always obtain urine culture
- Blood cultures if severe/hospitalized
- Consider imaging if not improving
- May need IV therapy initially
09Decision Pyelonephritis Severity
Outpatient vs Inpatient
- Outpatient if: mild-moderate, tolerating PO
- Inpatient if: severe sepsis, vomiting, pregnant
10Action Outpatient Pyelonephritis
Oral fluoroquinolone or TMP-SMX
- Ciprofloxacin 500mg BID x7 days, OR
- Levofloxacin 750mg daily x5-7 days, OR
- TMP-SMX DS BID x14 days (if susceptible)
- Consider initial IV dose if concern
- Path rejoins step 05Shared downstream outcome
11Action Inpatient Pyelonephritis
IV antibiotics
- Ceftriaxone 1g IV daily, OR
- Fluoroquinolone IV, OR
- Piperacillin-tazobactam if severe/MDR risk
- Switch to PO when improving
- Path rejoins step 05Shared downstream outcome
12Action Complicated UTI
Structural/functional abnormality
- Male UTI
- Pregnancy
- Catheter-associated
- Renal stones, obstruction
- Immunocompromised
- Recent instrumentation
13Action Complicated UTI Workup
More extensive evaluation needed
- Urine culture mandatory
- Consider CT for stones/abscess
- Blood cultures if febrile
- Urology consult if structural
- Remove/replace catheter if CAUTI
14Action Complicated UTI Treatment
Broader coverage, longer duration
- Fluoroquinolone or beta-lactam
- 7-14 days duration typically
- Culture-directed therapy when available
- Address underlying cause
- Path rejoins step 05Shared downstream outcome
Guideline Source
IDSA Guidelines for Treatment of Acute Uncomplicated Cystitis and Pyelonephritis
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not cover catheter-associated UTI (CAUTI) in detail
- Complicated UTI may need urology input
- Pregnancy UTI requires OB input
- Drug dosing not included - refer to protocols
- Local antibiogram should guide therapy
Contraindicated Populations
pregnancy
Applicable Regions
USEU
EU: EAU guidelines similar
US: Based on IDSA 2010 guidelines
Version 1Next review: 2027-01-11
Next steps
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Related Resources
Frequently Asked Questions
What is the Urinary Tract Infection Management?
The Urinary Tract Infection Management is a management clinical algorithm for Internal Medicine. It provides a structured decision tree to guide clinical decision-making, based on IDSA Guidelines for Treatment of Acute Uncomplicated Cystitis and Pyelonephritis.
What guideline is the Urinary Tract Infection Management based on?
This algorithm is based on IDSA Guidelines for Treatment of Acute Uncomplicated Cystitis and Pyelonephritis (DOI: 10.1086/650482).
What are the limitations of the Urinary Tract Infection Management?
Known limitations include: Does not cover catheter-associated UTI (CAUTI) in detail; Complicated UTI may need urology input; Pregnancy UTI requires OB input; Drug dosing not included - refer to protocols; Local antibiogram should guide therapy. Individual patient factors may require deviation from these recommendations.
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