Treatment
12
Table 1. Continued
UTI Syndrome and
Associated Clinical and
Microbiological
Findings
a
Recommended
Treatment and
Duration
b
Additional Comments
Acute pyelonephritis
Diagnostic Test Results:
≥100,000 CFUs/mL of
≤2 species of bacteria OR
≥100 CFUs/mL of ≥1
species of bacteria in a
specimen collected by in-
and-out catheter
Signs & Symptoms:
Non-localizing, suggesting
that the illness extends
beyond the bladder, such
as fever,
c
rigors/chills,
marked fatigue/malaise,
nausea or vomiting,
AND Localizing to the
genito-urinary tract, such
as dysuria, suprapubic
tenderness, costovertebral
angle tenderness, pelvic
or perineal pain (men),
new or worsening
incontinence, frequency,
urgency, or gross hematuria
Trimethoprim/
Sulfamethoxazole,
14 days
Beta-lactams,
10–14 days
Fluoroquinolones,
7 days
Nitrofurantoin and fosfomycin
should not be used to treat
pyelonephritis.
Pyelonephritis may present without
symptoms of cystitis.
Shorter (7–10 days) treatment with
trimethoprim/sulfamethoxazole may
be appropriate in select patients with
rapid defervescence.
Pelvic or perineal pain in men can
suggest accompanying prostatitis.
a
Clinical and microbiological findings in this table have been provided to highlight differences in
various UTI syndromes. PALTC settings are recommended to adapt one of the published clinical
algorithms to guide the diagnosis and decision to initiate antibiotics for residents with a suspected
UTI.
b
When choosing an antibiotic agent, clinicians will also need to consider additional factors
including (but not limited to) resident allergies, co-morbidities, potential drug-drug interactions,
availability, local resistance pattern/urine culture results, cost and overall clinical status. Similarly,
final treatment duration will also depend on overall clinical condition and response to the
treatment.
c
More recently published criteria usually define fever as: Single oral temperature of ≥100°F or
repeated oral temperatures of >99°F or increase in temperature of ≥2°F over baseline.
Source: Ashraf MS et al. Diagnosis, Treatment, and Prevention of Urinary Tract Infections in Post-
Acute and Long-Term Care Settings: A Consensus Statement From AMDA's Infection Advisory
Subcommittee. J Am Med Dir Assoc. 2020 Jan;21(1):12-24
