• University of Michigan Health System. Urinary tract infection. Ann Arbor (MI): University of Michigan Health System; 2005 May. 9 p. [10 references]

This is the current release of the guideline.

This guideline updates a previous version: University of Michigan Health System. UMHS urinary tract infection guideline. Ann Arbor (MI): University of Michigan Health System; 1999 Jun. 7 p.

Note from National Guideline Clearinghouse (NGC): The following key points summarize the content of the guideline. Refer to the full text for additional information, including detailed information on diagnosis, treatment regimens and costs.

The levels of evidence [A-D] are defined at the end of the "Major Recommendations" field.

Diagnosis

• History. Diagnosis is made primarily by history. In women with dysuria and frequency, in the absence of vaginitis, the diagnosis is urinary tract infection (UTI) 80% of the time [C].
• Phone triage. In women with prior history of uncomplicated urinary tract infections (UTIs), consider phone triage [C].
• Urinalysis. Urinalysis for detection of pyuria by dipstick or microscope has a sensitivity of 80-90% and a specificity of 50% for predicting UTI [B].
• No urine culture. Urine culture is NOT indicated in the vast majority of UTIs. Urine culture (UC) has a sensitivity of 50% (if threshold for positive is >10⁵ organisms); sensitivity can be increased to >90% if threshold is >10² organisms [C]. Consider urine culture only in recurrent UTI or in the presence of complicating factors.

Treatment

• First line: three days of trimethoprim/sulfa [A].
• Second line:
  • three days of quinolone (contraindicated in pregnancy) [A].
  • seven days of nitrofurantoin, amoxicillin, first-generation cephalosporin [A].

Follow-up

• No tests if asymptomatic. No laboratory follow-up is necessary if asymptomatic [B].
• For recurrent UTIs. In patients with recurrent UTIs (>3/year):
  • consider prophylaxis/self-initiated therapy [A]
  • urologic structural evaluation rarely indicated [D]

Definitions:

Levels of evidence:

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational trials
4. Opinion of expert panel

An algorithm is provided in the original guideline document for the diagnosis and management of urinary tract infection (UTI).

The type of evidence is identified and graded for the most significant recommendations (see "Major Recommendations").

• University of Michigan Health System. Urinary tract infection. Ann Arbor (MI): University of Michigan Health System; 2005 May. 9 p. [10 references]

Not applicable: The guideline was not adapted from another source.

1999 Jun (revised 2005 May)

University of Michigan Health System - Academic Institution

The University of Michigan Health System (UMHS) provides funding for guideline development. No external funds are used.

Urinary Tract Infection Guideline Team

Team Leader: Steven E. Gradwohl, MD, General Medicine

Team Members: Carol E. Chenoweth, MD, Infectious Diseases; Karen R. Fonde, MD, Family Practice; R. Van Harrison, PhD, Medical Education; Lauren B. Zoschnick, MD, Obstetrics & Gynecology

Guidelines Oversight Team: Connie J. Standiford, MD; Lee A. Green, MD, MPH; R. Van Harrison, PhD

The University of Michigan Health System endorses the Guidelines of the Association of American Medical Colleges and the Standards of the Accreditation Council for Continuing Medical Education that the individuals who present educational activities disclose significant relationships with commercial companies whose products or services are discussed. Disclosure of a relationship is not intended to suggest bias in the information presented, but is made to provide readers with information that might be of potential importance to their evaluation of the information.

Team Member; Company; Relationship

Carol E. Chenoweth, MD (None)

Karen R. Fonde, MD (None)

Steven E. Gradwohl, MD (None)

R. Van Harrison, PhD (None)

Lauren B. Zoschnick, MD (None)

This is the current release of the guideline.

This guideline updates a previous version: University of Michigan Health System. UMHS urinary tract infection guideline. Ann Arbor (MI): University of Michigan Health System; 1999 Jun. 7 p.

None available

This summary was completed by ECRI on August 21, 2000. The information was verified by the guideline developer on November 22, 2000. This summary was updated by ECRI on August 4, 2005. The updated information was verified by the guideline developer on August 10, 2005. This summary was updated by ECRI Institute on July 28, 2008 following the U.S. Food and Drug Administration advisory on fluoroquinolone antimicrobial drugs.

This NGC summary is based on the original guideline, which is copyrighted by the University of Michigan Health System (UMHS).