Uncomplicated UTI (cystitis) in women

IDSA2011

First-line for acute uncomplicated cystitis: nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for 5 days; TMP-SMX DS twice daily for 3 days if local resistance is 20% or less and no recent use; fosfomycin 3 g once (slightly less effective); or pivmecillinam (now available in the US). Fluoroquinolones work but should be reserved for uses other than cystitis. Beta-lactams only when others cannot be used. IDSA lists this guideline as archived while an update is in development.

AUA/CUA/SUFU2025

Recurrent UTI: offer cranberry for prophylaxis; methenamine hippurate and more water (if intake is below 1.5 L/day) are options. D-mannose alone may not be effective. Recommend vaginal estrogen for peri- and postmenopausal women unless contraindicated. Antibiotic prophylaxis is an option after discussing risks. Self-start therapy may be offered to select patients while awaiting cultures. No test-of-cure urinalysis or culture in asymptomatic patients.

USPSTF2019Grade B (pregnant); D (nonpregnant)

Screen pregnant persons for asymptomatic bacteriuria with a midstream clean-catch urine culture at the first prenatal visit or at 12 to 16 weeks, whichever is earlier. Do not screen nonpregnant adults for asymptomatic bacteriuria.

IDSA2025Grade Conditional recommendations

Complicated UTI (fever or other signs of infection beyond the bladder, including pyelonephritis; male sex alone does not make it complicated): choose empiric therapy by severity and resistance risk, avoiding a fluoroquinolone if one was used in the past 12 months. Switch IV to oral once improving. If improving, treat 5 to 7 days with a fluoroquinolone or 7 days with another agent, even with bacteremia, rather than 10 to 14 days; consider 10 to 14 days if acute bacterial prostatitis is suspected.