New Recommendations Aim to Reduce Antibiotics Misuse in Urinary Tract Infections
New national guidelines have been released to help healthcare providers safely triage and manage adults with suspected urinary tract infections (UTIs), with special consideration for virtual and telehealth consultations.
All guidelines offer expert consensus on when to prescribe antibiotics, order urine tests, or conduct in-person evaluations across outpatient settings. Separate algorithms address uncomplicated UTIs in non-pregnant women and in men.
The recommendations account for multiple care formats, including phone calls, patient portal messaging, video visits and asynchronous e-visits.
Patients presenting with signs of pyelonephritis, complicated cystitis, urinary obstruction, or non-UTI conditions such as diarrhea, genital discharge, or respiratory symptoms should be evaluated in person immediately. Providers are advised not to order urine testing or prescribe antibiotics solely based on changes in urine color without classic cystitis symptoms, including dysuria, urgency, frequency or suprapubic pain.
For non-pregnant women with typical cystitis symptoms and low risk of antibiotic resistance, empiric treatment without prior testing may be appropriate. However, men and patients at higher risk of resistance should undergo urinalysis with culture before starting antibiotics. In cases where testing or in-person evaluation is not feasible due to distance, transportation, or lab access, empiric therapy may be considered.
Lead author, Jennifer Meddings, emphasized, “Fewer patients are seen in person where urine samples can guide treatment. Providers need clear guidance on safely administering empiric antibiotics without a culture”.
The researchers say for patients with recurrent or complicated UTIs, off-label or travel-access vaccines may be considered.
