Describe the general principles.
Antibiotic treatment is recommended for all patients with symptomatic UTI.
The optimal therapy depends on disease severity, local resistance patterns, and patient characteristics (e.g., allergies).
Initial treatment is with an empiric regimen, which is maintained for uncomplicated cystitis.
In unclear or complicated cases, the regimen may subsequently have to be adjusted based on urine culture data.
Consider the need for supportive treatment.
Phenazopyridine, a urinary analgesic, can be used for symptomatic relief for a maximum of 2 days.
Oral analgesia, e.g., with NSAIDs, can provide additional relief.
Describe the treatment of uncomplicated lower UTI.
Management can typically be done in the outpatient setting with oral therapy.
Treatment duration depends on the chosen antibiotic agent.
Symptom relief can be expected to occur after an average of 36 hours. 
Persistent symptoms despite antibiotic therapy suggest complicated UTI and/or indicate the need to change the empiric therapy.
Empiric antibiotic treatment of uncomplicated lower UTIs
Nitrofurantoin for 5 days
Trimethoprim/sulfamethoxazole (TMP/SMX) for 3 days
Fosfomycin (single dose)
Second-line treatment: beta-lactam antibiotics for 5–7 days
Aminopenicillins plus beta-lactamase inhibitors, e.g., amoxicillin/clavulanic acid
Oral cephalosporins, e.g., cefpodoxime, cefdinir, or cefaclor
Alternatives: Consider fluoroquinolones, e.g., ciprofloxacin for 3 days for patients with previous infections with bacteria resistant to other drug classes. 
Describe the treatment of complicated lower UTI.
There are few recommendations for the empiric antibiotic treatment of complicated lower UTI.
Empiric antibiotic therapy should have broad-spectrum activity against the expected uropathogens.
Because UTIs in men can involve the prostate, antibiotics should be able to penetrate prostate tissue (e.g., fluoroquinolones, TMP/SMX).
In addition to antibiotic therapy, complicating factors (e.g., obstruction) should be treated, if possible.
For UTI in men, referral to urology may be warranted especially in the following cases:
Treatment failure or recurrent UTIs
Voiding difficulties or acute urine retention 
Suspected acute bacterial prostatitis
Hospitalization and initial intravenous treatment may be necessary in the following cases: 
Severe systemic symptoms, e.g., signs of shock
Inability to tolerate oral antibiotics
Severe comorbidities, e.g., immunocompromise or heart failure
Antibiotic treatment of complicated lower UTIs 
Antibiotic therapy must be adapted to culture results and is commonly given for 7–14 days.
Options for the initial empiric treatment of complicated lower UTIs include:
Fluoroquinolones PO or IV: e.g., ciprofloxacin or levofloxacin
Second-generation or third-generation cephalosporins: e.g., ceftriaxone
Extended-spectrum penicillins: e.g., ampicillin/sulbactam
Reasonable options if the pathogen is susceptible include: 
Fosfomycin (multiple doses)
Treatment regimens for UTI in men should include antibiotics that are able to penetrate prostate tissue (e.g., fluoroquinolones or TMP/SMX). Fosfomycin or nitrofurantoin are generally not adequate.
Describe the treatment of recurrent UTI.
Recurrent UTIs are common in women and are defined as ≥ 3 episodes of symptomatic, culture-proven UTI in one year or ≥ 2 episodes in 6 months. Management involves the implementation of preventive measures and antibacterial prophylaxis in addition to the antibiotic treatment of acute episodes.
Whenever possible, obtain a urine culture for every episode prior to initiating antibiotic therapy.
Choice of antibiotic
First recurrence: See “Antibiotic treatment for uncomplicated lower UTIs” and “Antibiotic treatment for complicated lower UTIs” for initial empiric regimens.
Regimens should be tailored to the patient and prior culture results.
Antibiotics must be adapted to the current culture results once available.
Antibiotic prophylaxis 
Indication: may be considered in all women with recurrent uncomplicated UTIs
Typically taken for 3–12 months with periodic reassessment
Trimethoprim (TMP) daily
Fosfomycin every 10 days
Intermittent or postcoital prophylaxis
Recommended for women who have recurrent UTIs associated with sexual activity
There is insufficient high-quality data to support the use of cranberry products for preventing UTIs. 
Topical estrogen therapy should be considered in postmenopausal women.
Behavioral modifications (e.g., increased fluid intake, postcoital voiding) may be helpful.
In male individuals
In pregnant women 
Increased risk of preterm labor and birth 
Hypertension and preeclampsia
Describe the prevention.
Behavioral modifications 
Increased fluid intake
Timely bladder voiding
Adequate genital hygiene
Clean intermittent catheterization
Indicated for individuals with neurogenic bladder
Reduces incidence of catheter-associated UTIs
Prophylaxis: indicated for recurrent urinary tract infections