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UTI Treatment Antibiotics

Category: Pharmacology > Infection & Prophylaxis

Overview​

Antibiotic treatment of urinary tract infection is stratified by anatomic site (cystitis vs. pyelonephritis), host factors (uncomplicated vs. complicated), and the presence of sepsis, drug-resistant organisms, or device-associated infection. The reconstructive urologist's UTI population skews toward the complicated end — neurogenic bladders, indwelling catheters, continent diversions, prosthetic devices, post-reconstruction anatomy — so empiric treatment strategies appropriate for uncomplicated outpatient cystitis often do not apply.

Guideline framework: IDSA 2025 complicated UTI guideline (Trautner/Cortés-Penfield/Gupta), IDSA 2026 antimicrobial-resistant gram-negative guidance (Tamma), 2024 WikiGuidelines UTI consensus (JAMA Network Open), IDSA 2019 asymptomatic bacteriuria guideline, and AUA recurrent UTI guideline (2025).[1][6][7][8][11]

Mechanism of Action​

Antibiotic classes used for UTI work through the following broad mechanisms:

ClassMechanismGU-relevant examples
NitrofuranMulti-target enzyme damage (DNA, ribosomal, cell-wall biosynthesis)Nitrofurantoin
Sulfonamide + dihydrofolate reductase inhibitorDual folate-pathway inhibitionTMP-SMX
Phosphonic acidBlocks peptidoglycan synthesis (MurA)Fosfomycin
FluoroquinoloneDNA gyrase + topoisomerase IV inhibitionCiprofloxacin, levofloxacin
β-lactamCell-wall synthesis (transpeptidase)Cephalexin, cefpodoxime, cefazolin, cefepime, ceftriaxone, piperacillin-tazobactam, carbapenems
β-lactam + β-lactamase inhibitorAdds protection against β-lactamasesAmoxicillin-clavulanate, piperacillin-tazobactam, ceftolozane-tazobactam, ceftazidime-avibactam
Aminoglycoside30S ribosomal inhibitionGentamicin, amikacin, tobramycin
Tetracycline30S ribosomal inhibitionDoxycycline (chronic prostatitis)
PolymyxinCell-membrane disruptionColistin (rescue for MDR Pseudomonas/Enterobacterales)
Siderophore cephalosporinIron-dependent cell-wall uptakeCefiderocol

Agents in This Class​

Oral agents for bladder-limited infection​

AgentKey featuresTypical cystitis dose
Nitrofurantoin (macrocrystal / monohydrate)Urine-concentrated; minimal systemic / microbiome impact; renal restrictions differ between current guidance and US labeling; see precautions; pulmonary fibrosis with long-term use100 mg PO BID × 5 days
TMP-SMX (trimethoprim-sulfamethoxazole)Broad coverage; local resistance often >20% limits empiric use; G6PD caution160/800 mg PO BID × 3 days
Fosfomycin (trometamol)Single-dose oral; useful in ESBL; lower efficacy than nitrofurantoin in head-to-head RCT; not for pyelonephritis3 g PO × 1
Pivmecillinam (Pivya)FDA-approved 2024 for uncomplicated UTI in women ≥18 y due to susceptible E. coli, P. mirabilis, S. saprophyticus; long European track record[17]185 mg PO TID × 3–7 days (US label)
Gepotidacin (Blujepa)First-in-class triazaacenaphthylene dual-target topoisomerase inhibitor; FDA-approved 2025 for uncomplicated UTI in females ≥12 y and ≥40 kg; non-inferior to nitrofurantoin in EAGLE-2 / EAGLE-3 phase 3 trials[18]1,500 mg PO BID × 5 days

Second-line oral / step-down agents​

AgentKey features
Cephalexinβ-lactam for uncomplicated UTI; short duration; no ESBL coverage
CefpodoximeOral 3rd-gen cephalosporin; not reliable for ESBL infections
Amoxicillin-clavulanateβ-lactamase-inhibitor combo; less effective than first-line for cystitis; selected susceptible non-ESBL urinary-source infections may permit oral step-down; not a default for ESBL bacteremia
CiprofloxacinWorkhorse fluoroquinolone; Pseudomonas coverage; boxed and other serious warnings; see precautions
LevofloxacinOnce-daily; similar profile to cipro
DoxycyclinePathogen-directed prostatitis, especially susceptible intracellular pathogens; not a blanket substitute for fluoroquinolones

IV agents (complicated UTI, urosepsis)​

AgentRole
CeftriaxoneIV workhorse; not reliable for ESBL infections; penetrates prostate/CSF
Cefepime4th-gen cephalosporin; Pseudomonas coverage; AmpC stability
Piperacillin-tazobactamBroad gram-negative including Pseudomonas; not preferred for ESBL bacteremia
Meropenem / Ertapenem / Imipenem-cilastatinCarbapenems; reserve for ESBL, multidrug-resistant organisms
AztreonamMonobactam; generally low cross-reactivity, but a ceftazidime allergy needs specific assessment because of the shared side chain[33]
Aminoglycosides (gentamicin, amikacin)Single-dose therapy can be used for selected cystitis; cUTI requires a full treatment plan with renal dosing and toxicity monitoring

Agents for resistant organisms (check regulatory status)​

AgentPrimary indication[8][9]
Ceftolozane-tazobactamDifficult-to-treat Pseudomonas aeruginosa; ESBL
Ceftazidime-avibactamKPC and OXA-48 carbapenem-resistant Enterobacterales; DTR Pseudomonas
Meropenem-vaborbactamKPC carbapenem-resistant Enterobacterales
Imipenem-cilastatin-relebactamDTR Pseudomonas; KPC CRE
CefiderocolSusceptibility-guided option for resistant gram-negative infection; organism/site-specific guidance is needed, particularly for Acinetobacter and Stenotrophomonas
Cefepime-taniborbactam (investigational)CERTAIN-1 found higher composite success than meropenem in the prespecified population with organisms susceptible to both drugs; this does not establish a routine CRE/DTR-Pseudomonas indication[20]
Cefepime-enmetazobactamESBL-producing Enterobacterales; superior to piperacillin-tazobactam for cUTI / pyelonephritis in the Kaye 2022 JAMA RCT — a carbapenem-sparing option[19]
PlazomicinNext-generation aminoglycoside; retains activity against aminoglycoside-resistant CRE; FDA-approved for cUTI

Indications in Reconstructive Urology​

Uncomplicated Cystitis​

Scope: The traditional short-course evidence chiefly concerns bladder-limited infection in nonpregnant women. Current IDSA classification also recognizes bladder-confined infection in afebrile men; menopausal status alone does not make an infection complicated. Catheter-associated infection, systemic illness and prostatic involvement require separate assessment.[6][8]

Common oral options (select by syndrome, susceptibility and local guidance):[1][2][3][4][17]

  • Nitrofurantoin 100 mg PO BID × 5 days
  • TMP-SMX 160/800 mg PO BID × 3 days (if local resistance <20%)
  • Fosfomycin 3 g PO × 1 dose — a head-to-head RCT found lower clinical resolution than a five-day nitrofurantoin regimen; it used nitrofurantoin 100 mg TID, rather than the commonly prescribed monohydrate/macrocrystal BID schedule.[32]
  • Pivmecillinam 185 mg PO TID × 3–7 days (US label) (Pivya, FDA-approved 2024)[17]

Newly FDA-approved option (first-in-class):

  • Gepotidacin 1,500 mg PO BID × 5 days (Blujepa) — non-inferior to nitrofurantoin in the EAGLE-2 / EAGLE-3 phase 3 trials; FDA-approved 2025 for females ≥12 y and ≥40 kg[18]

Not recommended as first-line:

  • Fluoroquinolones — excess adverse effects and resistance in uncomplicated setting
  • β-lactams (amoxicillin-clavulanate, cefpodoxime) — less effective than first-line

Network meta-analysis of duration (Kim 2020 Lancet ID, 61 RCTs): short-course (3-day TMP-SMX, 5-day nitrofurantoin) regimens with first-line agents are not inferior to longer courses for clinical or microbiological cure — longer courses carry more adverse events without benefit.[21]

E. coli causes approximately 75% of uncomplicated cystitis.[1][4]

Uncomplicated UTI in men​

Obtain a urine culture and assess for fever, retention and prostatic involvement. Seven-day TMP-SMX or fluoroquinolone courses have evidence in selected afebrile men; do not automatically apply this to every agent or febrile infection. EAU 2026 permits nitrofurantoin in younger men only when prostatic involvement has been reliably excluded and notes uncertainty about its optimal duration.[3][30]

Acute Uncomplicated Pyelonephritis​

Oral regimens (when local fluoroquinolone resistance <10%):

  • Ciprofloxacin 500 mg PO BID × 7 days or
  • Levofloxacin 750 mg PO daily × 5 days

TMP-SMX 160/800 mg PO BID is an option when susceptible. Fourteen days is the older regimen; IDSA 2025 suggests seven days of effective non-fluoroquinolone therapy in clinically improving cUTI/pyelonephritis, with important exclusions below.[2][23]

If empiric oral fluoroquinolone coverage is unreliable, an initial long-acting parenteral agent may be needed even in a stable outpatient; severe illness or inability to tolerate PO requires a broader IV plan.[5]

Examples of initial IV agents (adjust to severity, organism risk and renal function):

  • Ceftriaxone 1–2 g IV daily (workhorse)
  • Piperacillin-tazobactam 3.375 g IV q6h
  • Fluoroquinolone IV (ciprofloxacin 400 mg IV q12h or levofloxacin 750 mg IV daily)
  • Aminoglycoside 1-dose loading (gentamicin 5 mg/kg or amikacin 15 mg/kg) — bridging to oral once susceptibility known

Transition to oral therapy once susceptibility results available and clinically improving.

Complicated UTI / Urosepsis​

The reconstructive-urology workhorse scenario — neurogenic bladder, indwelling catheter, continent diversion, stricture, obstruction, prosthetic device, post-transplant, elderly.

IDSA 2025 redefinition: classification emphasizes infection extending beyond the bladder, including pyelonephritis/febrile or bacteremic UTI, prostatitis and catheter-associated UTI. Host factors still guide treatment; this is not a claim that all older patients or every anatomical abnormality automatically has systemic infection.[6]

IDSA 2025 four-step empiric framework:[6]

  1. Assess severity of illness (septic shock → sepsis → stable)
  2. Assess resistance risk factors (prior ESBL / MDR organism, recent antibiotic exposure, catheter, transplant, prior healthcare contact)
  3. Assess patient-specific considerations (allergy, renal function, drug interactions)
  4. Apply the local antibiogram with explicit susceptibility thresholds:
ScenarioSusceptibility threshold for empiric agentOptions
cUTI with septic shock≥90% local susceptibility3rd / 4th-gen cephalosporin, carbapenem, piperacillin-tazobactam, or fluoroquinolone
cUTI with sepsis (no shock)≥80% local susceptibility3rd / 4th-gen cephalosporin, carbapenem, piperacillin-tazobactam, or fluoroquinolone
cUTI without sepsisNo specific antibiogram threshold recommendation3rd / 4th-gen cephalosporin, piperacillin-tazobactam, or fluoroquinolone — prefer narrower options when appropriate; prior cultures or severe resistance may justify a carbapenem

De-escalation: once susceptibility known, narrow to the most targeted effective agent and — where feasible — switch to oral step-down therapy.

IV-to-oral transition (IDSA 2025): switch when the patient is clinically improving, tolerating PO, and has an effective oral option, including patients with gram-negative bacteremia provided source control is achieved.[22]

Duration (IDSA 2025):[23]

  • cUTI (including pyelonephritis): 5–7 days of a fluoroquinolone or 7 days of a non-fluoroquinolone
  • cUTI with gram-negative bacteremia: 7 days in patients improving on effective therapy

Count duration from the first effective dose. Short-course studies often excluded severe sepsis, catheters, immunocompromise, abscesses, CKD, prostatitis, complete obstruction and urinary surgery; individualize these cases and obtain source control. Suspected acute bacterial prostatitis in febrile men may require longer treatment.[23]

ESBL-Producing Enterobacterales​

IDSA 2026 separates bladder infection from cUTI. For susceptible ESBL cystitis, options include nitrofurantoin, TMP-SMX, pivmecillinam, gepotidacin, sulopenem/probenecid and selected single-dose aminoglycoside therapy. Oral fosfomycin is an alternative for E. coli, not a reliable choice for Klebsiella.[8]

For ESBL cUTI, susceptible TMP-SMX or fluoroquinolones, carbapenems and cefepime/enmetazobactam are preferred options. The 2026 guidance also discusses IV fosfomycin, aminoglycosides and piperacillin/tazobactam as alternatives in selected cases. Oral and IV fosfomycin are not interchangeable; oral fosfomycin is not initial pyelonephritis therapy.[8]

Difficult-to-Treat Resistant (DTR) Pseudomonas​

Use susceptibility-guided ceftolozane/tazobactam, ceftazidime/avibactam, imipenem/cilastatin/relebactam or cefiderocol for cUTI; cefiderocol is favored for metallo-β-lactamase-producing strains. An agent's place on a list does not establish superiority.[8]

Carbapenem-Resistant Enterobacterales (CRE)​

Determine the carbapenemase mechanism and susceptibility. KPC commonly directs selection toward meropenem/vaborbactam, ceftazidime/avibactam or imipenem/relebactam; OXA-48-like enzymes favor ceftazidime/avibactam. For invasive NDM infections, IDSA 2026 prefers aztreonam/avibactam or cefiderocol; ceftazidime/avibactam plus aztreonam is an alternative when the fixed combination is unavailable. Consult ID/pharmacy rather than assuming all CRE share a drug target.[8]

Acute Bacterial Prostatitis​

Broad-spectrum gram-negative coverage targeting E. coli, Klebsiella, Proteus, Pseudomonas:[12][13]

IV empiric:

  • Piperacillin-tazobactam
  • Ceftriaxone
  • Fluoroquinolones (ciprofloxacin / levofloxacin)

Oral step-down:

  • Ciprofloxacin 500 mg PO BID
  • Levofloxacin 500–750 mg PO daily
  • TMP-SMX 160/800 mg PO BID

Duration: 2–4 weeks. Individualize duration and drain an abscess or relieve obstruction when indicated.[12]

Chronic Bacterial Prostatitis​

Requires antibiotics that penetrate prostatic tissue (lipophilic, low protein binding).[12][14]

First-line (minimum 4 weeks):

  • Ciprofloxacin 500 mg PO BID
  • Levofloxacin 500–750 mg PO daily

Alternatives must be pathogen directed: TMP-SMX may be used for a susceptible organism. Doxycycline is chiefly for identified intracellular pathogens rather than an interchangeable Enterobacterales regimen. Multidose oral fosfomycin is an off-label specialist option in selected resistant cases; the duration and initial daily phase differ from single-dose cystitis treatment.[14][30]

Catheter-Associated UTI (CAUTI)​

  • Remove an unnecessary catheter; replace a still-needed catheter present >2 weeks and obtain a fresh specimen, without delaying urgent therapy in sepsis
  • Treatment duration typically 7 days for prompt resolution; 10–14 days for delayed response or complicated course
  • Agent selection per organism and susceptibility; local resistance matters

Asymptomatic Bacteriuria — When NOT to Treat​

Per IDSA 2019 ASB guideline:[11]

  • Do NOT treat in non-pregnant women, elderly, diabetic patients, spinal cord injury patients, functional urinary diversion, or catheter carriers solely because a culture is positive
  • DO treat in pregnancy, before endoscopic urologic procedures with mucosal trauma; kidney transplantation is not a blanket indication to eradicate ASB. Evidence in the first month after transplant is insufficient; later routine treatment is not recommended

Dosing & Administration​

Doses listed are for reference only. Confirm with current guidelines and institutional protocols. All doses assume normal renal function; adjust for CKD per package labeling.

SyndromeRegimenDuration
Uncomplicated cystitisNitrofurantoin 100 mg BID5 days
TMP-SMX 160/800 mg BID3 days
Fosfomycin 3 g1 dose
Pyelonephritis (PO)Ciprofloxacin 500 mg BIDUsually 7 days in improving patients
Levofloxacin 750 mg daily5 days
TMP-SMX 160/800 mg BID (if susceptible)See IDSA 2025 duration/exclusions above
Pyelonephritis initial IVCeftriaxone 1–2 g daily→ PO when improving
cUTI / urosepsisEffective agent by severity and susceptibilitySee short-course criteria/exclusions above; bacteremia alone does not mandate extension
Gram-negative bacteremia of urinary sourceEffective systemic therapy; selected oral step-downOften 7 days with clinical response and source control
Acute bacterial prostatitisIV pip-tazo or ceftriaxone → PO fluoroquinolone or TMP-SMX2–4 weeks
Chronic bacterial prostatitisCiprofloxacin 500 mg BID or levofloxacin 500–750 mg dailyMinimum 4 weeks
Alternative (chronic bacterial prostatitis)Pathogen-directed specialist regimenAgent- and organism-specific

High-dose oral β-lactam step-down (bacteremia of urinary origin)​

Examples used in selected susceptible urinary-source gram-negative bacteremia after stabilization and source control; IDSA notes that oral β-lactam evidence is more limited and sufficient bloodstream exposure matters:[6]

  • Amoxicillin 1000 mg PO q8h
  • Amoxicillin-clavulanate 875/125 mg PO q8h
  • Cephalexin 1000 mg PO q6h

These are high-dose examples, not interchangeable formulations or a blanket recommendation for ESBL bacteremia; confirm organism/MIC, renal dosing and absorption with pharmacy.

Contraindications & Precautions​

Nitrofurantoin​

  • Renal restriction: EAU/Beers guidance uses a threshold around 30; US Macrobid labeling still lists CrCl <60 as a contraindication. Follow the applicable local policy and distinguish guidance from labeling; avoid use for pyelonephritis or suspected prostatitis.[30][31]
  • Late pregnancy (≥38 weeks) — neonatal hemolysis risk
  • G6PD deficiency — hemolysis
  • Long-term use — pulmonary fibrosis, peripheral neuropathy, chronic hepatitis

TMP-SMX​

  • Sulfa allergy
  • G6PD deficiency
  • Late pregnancy — kernicterus risk
  • Hyperkalemia, renal impairment — potassium and creatinine changes
  • Drug interactions: warfarin (INR ↑), methotrexate, phenytoin, ACEi/ARBs (hyperkalemia)

Fluoroquinolones​

  • Boxed/major warnings: tendon injury, peripheral neuropathy, CNS effects and worsening myasthenia gravis; aortic aneurysm/dissection and dysglycemia are additional serious warnings, not all part of the boxed warning.[34]
  • QT prolongation — torsade risk with other QT-prolonging drugs
  • Avoid in pregnancy (limited data; animal evidence of cartilage damage)
  • Avoid in patients <18 years except specific indications

Aminoglycosides​

  • Nephrotoxicity — monitor creatinine
  • Ototoxicity — particularly in elderly; monitor audiometry in prolonged courses
  • Neuromuscular blockade — avoid with neuromuscular disease
  • Loading dose + extended interval preferred over traditional q8h dosing for efficacy and toxicity profile

Carbapenems​

  • Cross-reactivity with penicillin allergy — low but real (~1%)
  • Seizure risk at high doses or in renal failure (imipenem highest)
  • Reserve for resistant organisms — stewardship imperative

Resistance Considerations​

Do not treat a national all-Enterobacterales percentage as an E. coli cystitis antibiogram. Species, syndrome, setting and sampling year alter the estimate; use a recent, relevant local antibiogram and the patient's prior isolates.[15]

Local antibiogram guidance​

Use local antibiogram data to guide empiric therapy. Resistance varies substantially by:

  • Geographic region
  • Hospital vs. community
  • Patient population (catheter, transplant, neurogenic)
  • Prior antibiotic exposure (<90 days = higher resistance risk)

In a randomized vignette survey, both traditional and syndromic antibiograms improved simulated prescribing compared with no tool; the two formats performed similarly overall. This was not a clinical-outcome trial.[16]

Stewardship principles​

  • Shortest effective duration — short-course regimens match longer ones for cystitis
  • De-escalate when susceptibility data return
  • Step-down to oral when clinically improving
  • Reserve carbapenems for MDR organisms
  • Do NOT treat asymptomatic bacteriuria outside specific indications

Perioperative Considerations​

Before urologic procedures with mucosal trauma​

Per IDSA 2019 ASB guideline:[11]

  • Screen and treat asymptomatic bacteriuria before endoscopic procedures with mucosal disruption (e.g., TURP, URS and PCNL)
  • 1–2 doses of targeted antimicrobial therapy based on urine culture susceptibility
  • Initiate 30–60 minutes before incision (cephalosporins); vancomycin requires earlier initiation

For full perioperative framework including non-ASB prophylaxis,[10] see Perioperative Antibiotic Prophylaxis.

Post-reconstructive patients with persistent bacteriuria​

  • Continent diversions (Mitrofanoff, Indiana pouch, neobladder) — frequently colonized; do NOT treat asymptomatic colonization
  • Augmentation cystoplasty — similar; mucus and bacteriuria are expected
  • IPP, AUS — investigate symptomatic infection promptly, but an implant alone does not justify treatment of asymptomatic bacteriuria. IDSA suggests no routine ASB screening/treatment solely for implantation, while standard perioperative prophylaxis remains indicated.[11]

Evidence and practical interpretation​

Short-course cystitis regimens have randomized evidence, but guideline publication does not mean every recommendation is Level 1 evidence. IDSA 2025 grades cUTI duration and oral transition recommendations conditionally, with important exclusions. Use the syndrome-specific sections above rather than a single duration for every reconstructed tract.[6][22][23]

  • EAGLE-2/3 compared gepotidacin with nitrofurantoin; Pivya's approval evidence used different comparators. Approval does not mean that both drugs were noninferior to nitrofurantoin in the same evidence program.[17][18]
  • CERTAIN-1's primary comparison concerned organisms susceptible to both study drugs, not a dedicated trial establishing treatment of CRE or DTR Pseudomonas.[20]
  • Do not prescribe antibiotics for asymptomatic colonization or chronic pelvic pain without evidence of bacterial infection.

Newer US approvals: distinct indications​

DrugLabeled role and key prescribing limits
Sulopenem etzadroxil/probenecid (Orlynvah, 2024)Adult female uncomplicated UTI with limited/no alternative oral options; not cUTI or cUTI step-down. Check β-lactam allergy, uric-acid stones, blood dyscrasias and the contraindicated ketorolac interaction.[29]
IV fosfomycin (Contepo, October 2025)Adult cUTI including pyelonephritis from susceptible E. coli/K. pneumoniae; separate from oral fosfomycin. Requires renal dosing and attention to sodium load/electrolytes.[28]
Cefepime/zidebactam (Zaynich, May 2026)Adult cUTI including pyelonephritis from designated susceptible organisms. Label: 3 g IV every 8 hours over 1 hour for 7–10 days when eGFR ≥60; reduce with renal impairment and monitor for cefepime neurotoxicity.[27]
Tebipenem pivoxil (Utebzi, June 2026)Oral carbapenem for adult cUTI including pyelonephritis with limited/no alternative oral options. Label: 600 mg every 6 hours for 7–10 days at eGFR 60–150; use the separate renal schedules below 60, and it is not recommended above 150. Do not extend courses beyond labeling; carnitine deficiency and β-lactam hypersensitivity are contraindications, and concomitant valproate should be avoided.[26]

Pivya: the US label is 185 mg pivmecillinam (equivalent to 200 mg pivmecillinam hydrochloride) TID for 3–7 days. European/IDSA AMR dosing discussions include higher off-label regimens; do not present 400 mg TID as the US Pivya label. Check serious β-lactam hypersensitivity, carnitine deficiency and acute porphyria.[17][8]

Blujepa: for female uUTI at age ≥12 and weight ≥40 kg, 1,500 mg BID for five days after meals. Review QT risk, interacting CYP3A drugs, and severe renal/hepatic impairment; the separate gonorrhea regimen must not be used as a UTI schedule.[25]

See Also​

References​

1. Lee RA, Centor RM, Humphrey LL, et al. Appropriate use of short-course antibiotics in common infections: best practice advice from the American College of Physicians. Ann Intern Med. 2021;174(6):822–827. doi:10.7326/M20-7355

2. Dakkak M, Sabharwal M. Antibiotic courses for common infections: recommendations from the ACP. Am Fam Physician. 2022;105(2):205–206.

3. Kurotschka PK, Gágyor I, Ebell MH. Acute uncomplicated UTIs in adults: rapid evidence review. Am Fam Physician. 2024;109(2):167–174.

4. Grigoryan L, Trautner BW, Gupta K. Diagnosis and management of urinary tract infections in the outpatient setting: a review. JAMA. 2014;312(16):1677–84. doi:10.1001/jama.2014.12842

5. Johnson JR, Russo TA. Acute pyelonephritis in adults. N Engl J Med. 2018;378(1):48–59. doi:10.1056/NEJMcp1702758

6. Trautner BW, Cortés-Penfield NW, Gupta K, et al. IDSA 2025 guideline on management and treatment of complicated urinary tract infections: selection of antibiotic therapy for complicated UTI. Infectious Diseases Society of America; 2025. Current IDSA guideline and manuscripts.

7. Nelson Z, Aslan AT, Beahm NP, et al. Guidelines for the prevention, diagnosis, and management of urinary tract infections in pediatrics and adults: a WikiGuidelines group consensus statement. JAMA Netw Open. 2024;7(11):e2444495. doi:10.1001/jamanetworkopen.2024.44495

8. Tamma PD, Bonomo RA, Heil EL, Justo JA, Satlin MJ, Mathers AJ. IDSA 2026 guidance on treatment of antimicrobial-resistant gram-negative infections. Current web guidance accessed September 12, 2026; supersedes the 2024 edition.

9. Tamma PD, Aitken SL, Bonomo RA, et al. Infectious Diseases Society of America 2023 guidance on the treatment of antimicrobial resistant gram-negative infections. Clin Infect Dis. 2023;ciad428. doi:10.1093/cid/ciad428

10. Lightner DJ, Wymer K, Sanchez J, Kavoussi L. Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol. 2020;203(2):351–356. doi:10.1097/JU.0000000000000509

11. Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):e83–e110. doi:10.1093/cid/ciy1121

12. Borgert BJ, Wallen EM, Pham MN. Prostatitis. JAMA. 2025;334(11):1003–1013. doi:10.1001/jama.2025.11499

13. Lam JC, Stokes W. Acute and chronic prostatitis. Am Fam Physician. 2024;110(1):45–51.

14. Lam JC, Lang R, Stokes W. How I manage bacterial prostatitis. Clin Microbiol Infect. 2023;29(1):32–37. doi:10.1016/j.cmi.2022.05.035

15. Trautner BW, Cortés-Penfield NW, Gupta K, et al. IDSA 2025 guideline on management and treatment of complicated urinary tract infections: introduction and methods. Infectious Diseases Society of America; 2025. Current IDSA guideline and manuscripts.

16. Taylor LN, Wilson BM, Singh M, et al. Syndromic antibiograms and nursing home clinicians' antibiotic choices for urinary tract infections. JAMA Netw Open. 2023;6(12):e2349544. doi:10.1001/jamanetworkopen.2023.49544

17. US Food and Drug Administration/Alembic. Pivya prescribing information. Revised October 2025; accessed September 12, 2026.

18. Wagenlehner F, Perry CR, Hooton TM, et al. Oral gepotidacin versus nitrofurantoin in patients with uncomplicated urinary tract infection (EAGLE-2 and EAGLE-3): two randomised, controlled, double-blind, double-dummy, phase 3, non-inferiority trials. Lancet. 2024;403(10428):741–755. doi:10.1016/S0140-6736(23)02196-7

19. Kaye KS, Belley A, Barth P, et al. Effect of cefepime/enmetazobactam vs piperacillin/tazobactam on clinical cure and microbiological eradication in patients with complicated urinary tract infection or acute pyelonephritis: a randomized clinical trial. JAMA. 2022;328(13):1304–1314. doi:10.1001/jama.2022.17034

20. Wagenlehner FM, Gasink LB, McGovern PC, et al. Cefepime–taniborbactam in complicated urinary tract infection. N Engl J Med. 2024;390(7):611–622. doi:10.1056/NEJMoa2304748

21. Kim DK, Kim JH, Lee JY, et al. Reappraisal of the treatment duration of antibiotic regimens for acute uncomplicated cystitis in adult women: a systematic review and network meta-analysis of 61 randomised clinical trials. Lancet Infect Dis. 2020;20(9):1080–1088. doi:10.1016/S1473-3099(20)30121-3

22. Trautner BW, Cortés-Penfield NW, Gupta K, et al. IDSA 2025 guideline on management and treatment of complicated urinary tract infections: timing of intravenous-to-oral antibiotic transition. Infectious Diseases Society of America; 2025. Current IDSA guideline and manuscripts.

23. Trautner BW, Cortés-Penfield NW, Gupta K, et al. IDSA 2025 guideline on management and treatment of complicated urinary tract infections: duration of antibiotics for complicated UTI. Infectious Diseases Society of America; 2025. Current IDSA guideline and manuscripts.

24. AUA/CUA/SUFU. Recurrent uncomplicated urinary tract infections in women guideline. Amended 2025.

25. GSK. Blujepa US prescribing information. Revised February 2026.

26. FDA. Utebzi prescribing information. June 2026.

27. FDA. Zaynich prescribing information. May 2026.

28. FDA. Contepo prescribing information. October 2025.

29. FDA. Orlynvah approval and prescribing limits. October 2024.

30. EAU. Guidelines on urological infections. 2026; cystitis, renal function and bacterial prostatitis.

31. Macrobid US prescribing information; American Geriatrics Society. 2023 updated Beers Criteria. doi:10.1111/jgs.18372.

32. Huttner A, Kowalczyk A, Turjeman A, et al. Effect of 5-day nitrofurantoin vs single-dose fosfomycin on clinical resolution of uncomplicated lower urinary tract infection in women. JAMA. 2018;319:1781–1789. doi:10.1001/jama.2018.3627.

33. Canadian Society of Allergy and Clinical Immunology. Practical guide for evaluation and management of beta-lactam allergy. 2020 position statement.

34. FDA. Fluoroquinolone safety communication: aortic risks and related major warnings. December 2018.