Skip to main content

UTI Treatment Antibiotics

Category: Pharmacology > Infection & Prophylaxis Last reviewed: April 2026

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 2024 antimicrobial-resistant gram-negative guidance (Tamma), 2024 WikiGuidelines UTI consensus (JAMA Network Open), IDSA 2019 asymptomatic bacteriuria guideline, and AUA recurrent UTI guideline (2022).[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​

First-line oral agents (urine-concentrating, low-collateral-damage)​

AgentKey featuresTypical cystitis dose
Nitrofurantoin (macrocrystal / monohydrate)Urine-concentrated; minimal systemic / microbiome impact; avoid if CrCl <30 (reduced urinary concentration); 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]400 mg PO TID × 3 days
Gepotidacin (Blujepa)First-in-class triazaacenaphthylene dual-target topoisomerase inhibitor; FDA-approved 2025 for uncomplicated UTI in females ≥12 y; 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; ESBL variable
Amoxicillin-clavulanateβ-lactamase-inhibitor combo; less effective than first-line for cystitis; step-down from IV for bacteremia
CiprofloxacinWorkhorse fluoroquinolone; Pseudomonas coverage; FDA black-box (tendinopathy, aortic dissection, CNS, dysglycemia)
LevofloxacinOnce-daily; similar profile to cipro
DoxycyclineChronic prostatitis when fluoroquinolones can't be used

IV agents (complicated UTI, urosepsis)​

AgentRole
CeftriaxoneIV workhorse; ESBL-variable; 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
Aztreonamβ-lactam allergy alternative; monobactam; no cross-reactivity
Aminoglycosides (gentamicin, amikacin)Bactericidal; single-dose gentamicin 5 mg/kg for cUTI in selected patients

Newer agents for MDR gram-negative UTI​

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
CefiderocolSiderophore cephalosporin; carbapenem-resistant Enterobacterales, Stenotrophomonas, Acinetobacter; metallo-β-lactamase–producers
Cefepime-taniborbactamCRE (including metallo-β-lactamases NDM / VIM) and DTR P. aeruginosa; superior to meropenem in the CERTAIN-1 phase 3 trial (Wagenlehner 2024 NEJM)[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​

Definition: Lower UTI in non-pregnant, premenopausal female without structural or neurogenic abnormality, recent instrumentation, or device.

First-line agents:[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 — note: a head-to-head RCT found single-dose fosfomycin had higher clinical failure than 5-day nitrofurantoin[1]
  • Pivmecillinam 400 mg PO TID × 3 days (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[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​

Always obtain a urine culture. First-line agents are the same as in women — TMP-SMX, trimethoprim, or nitrofurantoin — but the standard duration is 7 days rather than 3–5.[3]

Acute Uncomplicated Pyelonephritis​

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

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

Oral TMP-SMX 160/800 mg PO BID × 14 days is acceptable if susceptibility confirmed — but not for empiric use due to ~20% resistance rates.[2]

If initial IV therapy required (severe illness, unable to tolerate PO):

  • 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: cUTI is infection extending beyond the bladder (fever, bacteremia, CVA tenderness, obstruction, or prostatic abscess), regardless of host comorbidities.[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 sepsisLower threshold acceptable3rd / 4th-gen cephalosporin, piperacillin-tazobactam, or fluoroquinolone — avoid carbapenems to preserve activity

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 (rather than 14) in patients improving on effective therapy — a substantial shortening from historical practice

ESBL-Producing Enterobacterales​

Preferred oral agents (when susceptibility confirmed):[8]

  • TMP-SMX
  • Ciprofloxacin / levofloxacin
  • Fosfomycin (cystitis only)
  • Nitrofurantoin (cystitis only; cannot be used for pyelonephritis)

Parenteral for ESBL:

  • Carbapenems (ertapenem, meropenem, imipenem-cilastatin) — reserve for resistant organisms or when oral options cannot be used
  • Ceftolozane-tazobactam, ceftazidime-avibactam — additional options

Difficult-to-Treat Resistant (DTR) Pseudomonas​

Per IDSA 2024 guidance:[8][9]

  • Ceftolozane-tazobactam (preferred)
  • Ceftazidime-avibactam
  • Imipenem-cilastatin-relebactam
  • Cefiderocol (metallo-β-lactamase producers)

Carbapenem-Resistant Enterobacterales (CRE)​

By β-lactamase type:[8]

  • KPC-producers: meropenem-vaborbactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam
  • OXA-48-producers: ceftazidime-avibactam, cefiderocol
  • Metallo-β-lactamase-producers (NDM, VIM, IMP): cefiderocol, ceftazidime-avibactam + aztreonam combination, cefepime-taniborbactam (emerging)

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. Clinical cure rates 92–97% with appropriate therapy and adequate duration.[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 (4–6 weeks) when fluoroquinolones cannot be used:

  • TMP-SMX 160/800 mg PO BID
  • Doxycycline 100 mg PO BID
  • Fosfomycin 3 g PO every 48–72 hours (emerging data for chronic prostatitis)

Catheter-Associated UTI (CAUTI)​

  • Remove / replace the catheter if indwelling >2 weeks before starting antibiotics
  • 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 (unless the catheter is being removed)
  • DO treat in pregnancy, before endoscopic urologic procedures with mucosal trauma, and pre-renal transplant

Dosing & Administration​

warning

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
Uncomplicated pyelonephritis (PO)Ciprofloxacin 500 mg BID5–7 days
Levofloxacin 750 mg daily5 days
TMP-SMX 160/800 mg BID (if susceptible)14 days
Pyelonephritis initial IVCeftriaxone 1–2 g daily→ PO when improving
cUTI / urosepsisCeftriaxone, cefepime, pip-tazo, meropenem per severity7–14 days (can extend if bacteremia)
Bacteremia of urinary source7–14 days total (IV + PO step-down); high-dose oral β-lactam step-down acceptable—
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 (CP)TMP-SMX 160/800 mg BID, doxycycline 100 mg BID, fosfomycin 3 g q48–72h4–6 weeks

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

Increasingly used as step-down therapy for gram-negative bacteremia of urinary origin per IDSA 2025 cUTI guideline:[6]

  • Amoxicillin 1000 mg PO q8h
  • Amoxicillin-clavulanate 875/125 mg PO q8h (or 1000/62.5 mg)
  • Cephalexin 1000 mg PO q6h

Use when susceptibility supports, patient is clinically improving, and can tolerate PO.

Contraindications & Precautions​

Nitrofurantoin​

  • CrCl <30 mL/min — reduced urinary concentration, ineffective
  • 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​

  • FDA black-box: tendinopathy / rupture, aortic aneurysm / dissection, peripheral neuropathy, CNS effects, dysglycemia
  • 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​

Current U.S. Enterobacterales urinary-isolate resistance rates:[15]

AgentAmbulatory / inpatient resistance
Fluoroquinolones~22%
TMP-SMX22–25%
Nitrofurantoin22–27%

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)

Syndromic antibiograms — weighted by local UTI syndrome patterns — outperform traditional antibiograms for empiric UTI therapy selection.[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 (TURP, URS, PCNL, IPP, AUS, urethroplasty)
  • 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, 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 — threshold to treat is LOW given device-infection consequences; always treat symptomatic infection immediately

Evidence Summary​

IndicationEvidence LevelKey Guideline / TrialNotes
Uncomplicated cystitis short-courseLevel 1IDSA 2011 (historical); WikiGuidelines 2024[7]; ACP 2021[1]Nitrofurantoin 5d / TMP-SMX 3d / fosfo 1-dose
Uncomplicated pyelonephritisLevel 1Johnson/Russo NEJM 2018[5]; WikiGuidelinesFluoroquinolone 5–7d; beta-lactam 14d
Uncomplicated cystitis durationLevel 1Kim 2020 Lancet ID network meta (61 RCTs)[21]Short-course first-line agents non-inferior to longer
Pivmecillinam (Pivya)Level 1FDA approval 2024[17]First-line for uncomplicated UTI in women ≥18 y
Gepotidacin (Blujepa)Level 1EAGLE-2 / EAGLE-3[18]First-in-class; non-inferior to nitrofurantoin
Complicated UTILevel 1IDSA 2025 cUTI guideline[6][22][23]4-step empiric framework; 7-day bacteremia; preserve carbapenems
Cefepime-enmetazobactam for ESBL cUTILevel 1Kaye 2022 JAMA RCT[19]Superior to piperacillin-tazobactam — carbapenem-sparing
Cefepime-taniborbactam for CRE / DTR-Pseudomonas cUTILevel 1CERTAIN-1 NEJM 2024[20]Superior to meropenem; broad β-lactamase coverage
MDR gram-negative UTILevel 1IDSA 2024 AMR guidance[8][9]Agent by resistance mechanism
Asymptomatic bacteriuriaLevel 1IDSA 2019 ASB guideline[11]Do NOT treat outside specific indications
Acute prostatitisLevel 2AUA prostatitis framework[12][13]2–4 weeks; broad-spectrum initially
Chronic prostatitisLevel 2Lam 2023 CMI[14]≥4 weeks fluoroquinolone; TMP-SMX/doxy/fosfo alternatives
Perioperative UTI preventionLevel 1AUA BPS 2020[10]Single-dose for GU mucosal-disrupting procedures

Practical Pearls​

  1. Do not treat asymptomatic bacteriuria in neurogenic, diabetic, elderly, catheter, or diversion patients unless pregnant or before mucosal-disrupting GU surgery.
  2. Short-course wins. 3-day TMP-SMX, 5-day nitrofurantoin, single-dose fosfomycin — for uncomplicated cystitis, longer courses don't help.
  3. Fluoroquinolones are not first-line for uncomplicated cystitis — AE burden and resistance preserve them for pyelonephritis and prostatitis.
  4. Nitrofurantoin needs working kidneys — CrCl <30 makes it ineffective (not just a renal-adjustment issue — the drug doesn't concentrate in urine at low GFR).
  5. Chronic prostatitis requires tissue penetration — fluoroquinolones, TMP-SMX, doxycycline, fosfomycin penetrate prostate; β-lactams don't. Treat for minimum 4 weeks.
  6. Local antibiogram > empiric textbook. Check your institution's resistance data before prescribing.
  7. High-dose oral β-lactam step-down (amoxicillin 1 g q8h, cephalexin 1 g q6h) is now acceptable for gram-negative bacteremia of urinary origin — use it to shorten IV duration.
  8. ESBL organisms are now common enough that culture-guided de-escalation matters for every complicated UTI.
  9. DTR Pseudomonas = ceftolozane-tazobactam or ceftazidime-avibactam first; cefiderocol for metallo-β-lactamases.
  10. Asymptomatic bacteriuria before mucosal-disrupting GU surgery — treat with 1–2 doses of culture-targeted antibiotic started 30–60 min pre-incision.
  11. Pivmecillinam and gepotidacin are new first-line options — both were FDA-approved in 2024–2025 for uncomplicated UTI in women; non-inferior to nitrofurantoin in head-to-head RCTs.[17][18]
  12. Gram-negative bacteremia of urinary origin is 7 days, not 14. The IDSA 2025 cUTI guideline formally endorses this shortening when the patient is improving on effective therapy.[23]
  13. Men get 7 days for uncomplicated UTI. Do not treat men with the 3-day / 5-day women's regimens.[3]
  14. For ESBL cUTI, cefepime-enmetazobactam is a carbapenem-sparing option with class-I superiority over piperacillin-tazobactam (Kaye 2022).[19]
  15. For CRE or DTR-Pseudomonas cUTI, cefepime-taniborbactam covers metallo-β-lactamases and was superior to meropenem in CERTAIN-1.[20]
  16. Fosfomycin single-dose is convenient but not the strongest cystitis agent — a head-to-head RCT showed higher clinical failure than 5-day nitrofurantoin. Reserve when resistance or intolerance limits alternatives.[1]

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.

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, Heil EL, Justo JA, et al. Infectious Diseases Society of America 2024 guidance on the treatment of antimicrobial-resistant gram-negative infections. Clin Infect Dis. 2024;ciae403. doi:10.1093/cid/ciae403

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.

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. Pivmecillinam (Pivya) — prescribing information. Approved 2024.

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.

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.

24. Anger JT, Bixler BR, Holmes RS, et al. Updates to recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. J Urol. 2022;208(3):536–541. doi:10.1097/JU.0000000000002860