urinary tract infections

Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults A WikiGuidelines Group Consensus Statement

Nathan Hinkle — Wed, 17 Jun 2026 01:19:59 +0000

Date Added:

June 16, 2026

Journal/Publication:

JAMA Network Open

Publisher:

The American Medical Association

Publication Date:

November 4, 2024

Pages:

1-29

URL:

Guidelines for the Prevention, Diagnosis and Management of Urinary Tract Infections in Pediatrics and Adults A Wiki Guidelines Group Consensus Statement

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

doi:10.1001/jamanetworkopen.2024.44495

Keywords

urinary tract infections

pediatrics

Treatment guidelines

MeSH

urinary tract infections

risk assessment

RPR Commentary: Suggested guidelines from the WikiGuidelines Group for diagnosis and management of children and adults with urinary tract infections. James W. Molds, MD, MPH

Free full text

View

Importance Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence.

Objective To create a clinical guideline for the diagnosis and management of urinary tract infections that addresses the gap between the evidence and recommendation strength.

Evidence Review This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In May 2023, new and existing members were solicited for questions on urinary tract infection prevention, diagnosis, and management. For each topic, literature searches were conducted up until early 2024 in any language. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were developed discussing the available literature and associated risks and benefits of various approaches.

Findings A total of 54 members representing 12 countries reviewed 914 articles and submitted information relevant to 5 sections: prophylaxis and prevention (7 questions), diagnosis and diagnostic stewardship (7 questions), empirical treatment (3 questions), definitive treatment and antimicrobial stewardship (10 questions), and special populations and genitourinary syndromes (10 questions). Of 37 unique questions, a clear recommendation could be provided for 6 questions. In 3 of the remaining questions, a clear recommendation could only be provided for certain aspects of the question. Clinical reviews were generated for the remaining questions and aspects of questions not meeting criteria for a clear recommendation.

Conclusions and Relevance In this consensus statement that applied the WikiGuidelines method for clinical guideline development, the majority of topics relating to prevention, diagnosis, and treatment of urinary tract infections lack high-quality prospective data and clear recommendations could not be made. Randomized clinical trials are underway to address some of these gaps; however further research is of utmost importance to inform true evidence-based, rather than eminence-based practice.

Author/s:

Zachary Nelson, Abdullah Tarik Aslan, Nathan P. Beahm

What Is Prostatitis?

Megan George — Tue, 20 Jan 2026 15:03:51 +0000

Date Added:

January 20, 2026

Journal/Publication:

JAMA Patient Page

Publication Date:

January 8, 2026

URL:

What Is Prostatitis?

Type:

Patient Education Materials

Format:

Poster

DOI (1):

10.1001/jama.2025.20559

Keywords

Prostatic Hyperplasia

MeSH

Lower Urinary Tract Symptoms

urinary tract infections

Immunosuppression Therapy

Pelvic Pain

Urinary Retention

Prostatic Hyperplasia

Prostate

Information for patients on prostatitis. James W. Mold, MD, MPH

View

Prostatitis involves infection, inflammation, or pain in the prostate gland and affects about 9% of men during their lifetime.

What Is Acute Bacterial Prostatitis?
Acute bacterial prostatitis is a urinary tract infection that involves the prostate.1 Patients with acute prostatitis typically have fever, chills, pelvic pain, sudden onset of frequent urination, and pain or burning during urination. Some patients cannot empty their bladder adequately (urinary retention).

Risk factors include medical procedures such as cystoscopy, urethral catheterization, prostate biopsy, urinary obstruction such as benign prostatic hyperplasia and strictures, anal intercourse without condom use, immunosuppression, and certain neurological disorders such as multiple sclerosis, stroke, and spinal cord injury. Digital rectal examination often reveals prostate swelling and tenderness. The diagnosis of acute bacterial prostatitis is made based on symptoms, urinalysis, and urine culture. First-line treatment is 2 to 4 weeks of antibiotics. Men with urinary retention due to a swollen prostate should have a urinary catheter placed to relieve discomfort and to drain the infected urine.

What Is Chronic Bacterial Prostatitis?
Chronic bacterial prostatitis is a persistent bacterial infection of the prostate despite antibiotic therapy. Patients typically do not have fever or chills, and between episodes of infection they may have no symptoms or have persistent pelvic pain and/or lower urinary tract symptoms.

Risk factors include age 50 years or older, prior acute bacterial prostatitis, urethral surgery or catheterization, anal intercourse without condom use, and genitourinary tuberculosis. The diagnosis is made when multiple urine culture samples grow the same bacterial strain during episodes of urinary tract infection. First-line treatment for chronic bacterial prostatitis is at least 4 weeks of oral antibiotics such as ciprofloxacin or levofloxacin.

Author/s:

Rebecca Voelker

Prostatitis: A Review

Megan George — Tue, 12 Aug 2025 13:07:09 +0000

Date Added:

August 12, 2025

Journal/Publication:

JAMA

Publication Date:

August 11, 2025

URL:

Prostatitis: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.11499

Keywords

PMID (1):

40788632

MeSH

urinary tract infections

anti-bacterial agents

Escherichia coli

Urinary Retention

A review of our current understanding of prostatitis. James W. Mold, MD, MPH

View

Importance Prostatitis is defined as infection, inflammation, or pain of the prostate gland and affects approximately 9.3% of men in their lifetime.

Observations Acute bacterial prostatitis consists of a urinary tract infection (UTI) that includes infection of the prostate, typically associated with fever or chills and caused by gram-negative bacteria, such as Escherichia coli, Klebsiella, or Pseudomonas, in 80% to 97% of cases. First-line therapy for acute prostatitis is broad-spectrum intravenous or oral antibiotics, such as intravenous piperacillin-tazobactam, ceftriaxone, or oral ciprofloxacin, which has a 92% to 97% success rate when prescribed for 2 to 4 weeks for people with febrile UTI and acute prostatitis. Chronic bacterial prostatitis is defined as a persistent bacterial infection of the prostate, typically presenting as recurrent UTIs from the same strain. Up to 74% of chronic bacterial prostatitis diagnoses are due to gram-negative organisms, such as E coli. First-line therapy for chronic bacterial prostatitis is a minimum 4-week course of levofloxacin or ciprofloxacin. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) presents as pelvic pain or discomfort for at least 3 months and is associated with urinary symptoms, such as urinary frequency. CP/CPPS is diagnosed when evaluation, including history and physical examination, urine culture, and postvoid residual measurement, does not identify other causes for the symptoms, such as infection, cancer, urinary obstruction, or urinary retention. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) measures symptom severity (scale of 0-43), with a 6-point change considered clinically meaningful. First-line oral therapy for CP/CPPS with urinary symptoms is α-blockers (eg, tamsulosin, alfuzosin; ΔNIH-CPSI score difference vs placebo = −10.8 to −4.8). Other oral therapies are associated with modest changes in NIH-CPSI score compared with placebo, including anti-inflammatory drugs (eg, ibuprofen; ΔNIH-CPSI score difference = −2.5 to −1.7), pregabalin (ΔNIH-CPSI score difference = −2.4), and pollen extract (ΔNIH-CPSI score difference = −2.49).

Conclusions and Relevance Prostatitis includes acute bacterial prostatitis, chronic bacterial prostatitis, and CP/CPPS, each of which is diagnosed and treated differently. First-line treatments are broad-spectrum antibiotics for acute bacterial prostatitis (such as piperacillin-tazobactam, ceftriaxone, or ciprofloxacin), at least 4 weeks of fluoroquinolones for chronic bacterial prostatitis, and α-blockers for CP/CPPS with urinary symptoms.

Author/s:

Benjamin J Borgert, Eric M Wallen, Minh N Pham

Non-Surgical Management of Urinary Incontinence

Alex Haga — Tue, 25 Feb 2025 17:42:11 +0000

Date Added:

February 25, 2025

Journal/Publication:

The Journal of the American Board of Family Medicine

Publication Date:

September 1, 2024

Issue:

Volume:

Pages:

909-918

URL:

Non-Surgical Management of Urinary Incontinence

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.3122/jabfm.2023.230471R1

Keywords

urinary incontinence

incontinence

stress urinary incontinence

MeSH

urinary tract infections

A review of the non-surgical management of urinary incontinence. James W. Mold, MD, MPH

Free full text

View

Urinary incontinence management varies depending on the type of incontinence and severity of symptoms. Types of incontinence include stress (SUI), urge or overactive bladder (OAB), mixed, neurogenic, and overflow incontinence. First-line treatment for OAB and SUI is nonpharmacologic management. Behavioral therapy is first-line treatment for urge incontinence. Vaginal mechanical devices (cones, pessaries, and urethral plugs), pelvic floor muscle training, and electroacupuncture are recommended as first-line treatment for women with SUI. Biofeedback and electric muscle stimulation can be adjunctive therapy for SUI. Antimuscarinics and β-3 agonists can be used as adjective therapy for those with OAB who do not improve with behavioral therapy. β-3 agonists have less anticholinergic side effects compared with antimuscarinics for OAB. Adverse medication effects can often lead to discontinuation due to poor tolerability. Third-line therapies are for those who fail conservative and pharmacologic therapies and lack high-grade evidence. Neuromodulation, neurotoxin injections, vaginal laser therapy, and acupuncture are third-line in OAB management. Pharmacologic management with α-1-blockers is recommended as first-line treatment for moderate to severe overflow incontinence from BPH. 5-α reductase inhibitors can be used as an adjunct medication in those with refractory overflow incontinence symptoms and a PSA ≥ 1.5 mg/dL. Clean intermittent catheterization is first-line therapy for neurogenic bladder but can increase risk of catheter-associated urinary tract infection. Clinicians should assess type of incontinence, patient goals, side effect profile, and tolerability to determine an individualized treatment plan for each patient.

Author/s:

Ranna Al-Dossari, Monica Kalra, Julie Adkison, Bich-May Nguyen

Urinary tract infections after menopause

Alex Haga — Tue, 11 Feb 2025 23:25:58 +0000

Date Added:

February 11, 2025

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

February 2, 2025

Issue:

Volume:

197

Pages:

E96

URL:

Urinary tract infections after menopause

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.241258

Keywords

urinary tract infections

UTIs

postmenopause

PMID (1):

39900362

MeSH

postmenopause

urinary tract infections

menopause

A concise review of the diagnosis and management of UTIs in post menopausal women. James W. Mold, MD, MPH

Free full text

View

No abstract is included with this article.

Author/s:

Erin A Brennand, Jayna Holroyd-Leduc

Genital Herpes

Alex Haga — Tue, 20 Aug 2024 20:03:33 +0000

Date Added:

August 20, 2024

Journal/Publication:

JAMA

Publication Date:

August 14, 2024

URL:

Genital Herpes

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.12743

Keywords

sexually transmitted diseases

urinary tract infections

herpes

genital herpes

PMID (1):

39141407

MeSH

sexually transmitted diseases

urinary tract infections

Genitalia

A review of what we currently understand about genital herpes simplex infections. James W Mold, MD, MPH

Free full text

View

This JAMA Insights examines the history, diagnosis, prevention, and stigma of genital herpes infection in the US and explores treatments such as suppressive therapy.

Author/s:

Christine Johnston, Anna Wald

What Should I Know About Recurrent UTIs in Older Women?

Alex Haga — Thu, 13 Jun 2024 21:47:57 +0000

Date Added:

June 13, 2024

Journal/Publication:

JAMA Internal Medicine

Publication Date:

June 10, 2024

URL:

What Should I Know About Recurrent UTIs in Older Women?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamainternmed.2024.1854

Keywords

urinary tract infections

female

PMID (1):

38857042

MeSH

female

Urinary Bladder

Urination

urinary tract infections

Vagina

menopause

Information for older women and their caregivers about diagnosis and treatment of suspected urinary tract infections. James W. Mold, MD, MPH

Free full text

View

This JAMA Internal Medicine Patient Page describes urinary tract infections, their causes, and how to treat them and prevent future episodes.

Author/s:

Sonali D Advani, Kimberly C Claeys, Nazema Y Siddiqui

Recurrent Urinary Tract Infection in Older Outpatient Women

Alex Haga — Thu, 13 Jun 2024 21:35:58 +0000

Date Added:

June 13, 2024

Journal/Publication:

JAMA Internal Medicine

Publisher:

JAMA

Publication Date:

June 10, 2024

URL:

Recurrent Urinary Tract Infection in Older Outpatient Women

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2024.1069

Keywords

urinary tract infections

PMID (1):

38856992

MeSH

urinary tract infections

A review of some of the challenges involved in the diagnosis and management of urinary tract infections in older women. James W. Mold, MD, MPH

Free full text

View

This Clinical Insights discusses special considerations in recurrent urinary tract infection diagnosis and management in older women.

Author/s:

Alison J Huang, Deborah Grady, Lona Mody

Role of biofilm in catheter-associated urinary tract infection

Bethie Seay — Thu, 23 Sep 2021 05:00:00 +0000

Date Added:

September 23, 2021

Journal/Publication:

American Journal of Infection Control

Publication Date:

May 19, 2004

Issue:

Volume:

Pages:

177-183

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1016/j.ajic.2003.08.005

MeSH

Urinary Catheters

Bacteriuria

Catheters, Indwelling

Reinfection

Urinary Catheterization

urinary tract infections

Biofilms

anti-bacterial agents

Biological Products

A classic article on urinary tract infections in patients with indwelling catheters.

View

The predominant form of life for the majority of microorganisms in any hydrated biologic system is a cooperative community termed a “biofilm.” A biofilm on an indwelling urinary catheter consists of adherent microorganisms, their extracellular products, and host components deposited on the catheter. The biofilm mode of life conveys a survival advantage to the microorganisms associated with it and, thus, biofilm on urinary catheters results in persistent infections that are resistant to antimicrobial therapy. Because chronic catheterization leads almost inevitably to bacteriuria, routine treatment of asymptomatic bacteriuria in persons who are catheterized is not recommended. When symptoms of a urinary tract infection develop in a person who is catheterized, changing the catheter before collecting urine improves the accuracy of urine culture results. Changing the catheter may also improve the response to antibiotic therapy by removing the biofilm that probably contains the infecting organisms and that can serve as a nidus for reinfection. Currently, no proven effective strategies exist for prevention of catheter-associated urinary tract infection in persons who are chronically catheterized.

Author/s:

Trautner, B. W., Darouiche, R. O.

Effect of 7 vs 14 Days of Antibiotic Therapy on Resolution of Symptoms Among Afebrile Men With Urinary Tract Infection: A Randomized Clinical Trial

Bethie Seay — Thu, 23 Sep 2021 05:00:00 +0000

Date Added:

September 23, 2021

Journal/Publication:

JAMA

Publication Date:

July 27, 2021

Issue:

Volume:

326

Pages:

324-331

Type:

Clinical Research Results

DOI (1):

doi:10.1001/jama.2021.9899

MeSH

Humans

male

trimethoprim, sulfamethoxazole drug combination

Ciprofloxacin

anti-bacterial agents

urinary tract infections

Communicable Diseases

Treatment Adherence and Compliance

This RCT found that 7 days of antibiotics were sufficient for treatment of symptomatic UTI in afebrile men.

View

Importance Determination of optimal treatment durations for common infectious diseases is an important strategy to preserve antibiotic effectiveness.

Objective To determine whether 7 days of treatment is noninferior to 14 days when using ciprofloxacin or trimethoprim/sulfamethoxazole to treat urinary tract infection (UTI) in afebrile men.

Design, Setting, and Participants Randomized, double-blind, placebo-controlled noninferiority trial of afebrile men with presumed symptomatic UTI treated with ciprofloxacin or trimethoprim/sulfamethoxazole at 2 US Veterans Affairs medical centers (enrollment, April 2014 through December 2019; final follow-up, January 28, 2020). Of 1058 eligible men, 272 were randomized.

Interventions Participants continued the antibiotic prescribed by their treating clinician for 7 days of treatment and were randomized to receive continued antibiotic therapy (n = 136) or placebo (n = 136) for days 8 to 14 of treatment.

Main Outcomes and Measures The prespecified primary outcome was resolution of UTI symptoms by 14 days after completion of active antibiotic treatment. A noninferiority margin of 10% was selected. The as-treated population (participants who took ≥26 of 28 doses and missed no more than 2 consecutive doses) was used for the primary analysis, and a secondary analysis included all patients as randomized, regardless of treatment adherence. Secondary outcomes included recurrence of UTI symptoms and/or adverse events within 28 days of stopping study medication.

Results Among 272 patients (median [interquartile range] age, 69 [62-73] years) who were randomized, 100% completed the trial and 254 (93.4%) were included in the primary as-treated analysis. Symptom resolution occurred in 122/131 (93.1%) participants in the 7-day group vs 111/123 (90.2%) in the 14-day group (difference, 2.9% [1-sided 97.5% CI, –5.2% to ∞]), meeting the noninferiority criterion. In the secondary as-randomized analysis, symptom resolution occurred in 125/136 (91.9%) participants in the 7-day group vs 123/136 (90.4%) in the 14-day group (difference, 1.5% [1-sided 97.5% CI, –5.8% to ∞]) Recurrence of UTI symptoms occurred in 13/131 (9.9%) participants in the 7-day group vs 15/123 (12.9%) in the 14-day group (difference, –3.0% [95% CI, –10.8% to 6.2%]; P = .70). Adverse events occurred in 28/136 (20.6%) participants in the 7-day group vs 33/136 (24.3%) in the 14-day group.

Conclusions and Relevance Among afebrile men with suspected UTI, treatment with ciprofloxacin or trimethoprim/sulfamethoxazole for 7 days was noninferior to 14 days of treatment with regard to resolution of UTI symptoms by 14 days after antibiotic therapy. The findings support the use of a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole as an alternative to a 14-day course for treatment of afebrile men with UTI.

Trial Registration ClinicalTrials.gov identifier: NCT01994538

Author/s:

Drekonja, D. M., Trautner, B., Amundson, C.

Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

Jeffrey Wilson — Mon, 22 Oct 2018 16:08:25 +0000

Date Added:

October 22, 2018

Journal/Publication:

Comparative Effectiveness Review

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

August 8, 2018

Issue:

212

URL:

Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.23970/AHRQEPCCER212

Keywords

urinary tract infections

MeSH

botulinum toxins, type A

urinary tract infections

This is a concise summary of the evidence regarding management of stress and urge-type urinary incontinence in women.

Free full text

Introduction. About 17 percent of adult women have had urinary incontinence (UI), classified as stress, urgency, or mixed. Stress UI is associated with an inability to retain urine with activities that increase intraabdominal pressure. Urgency UI is associated with the sudden, compelling urge to void. Mixed UI occurs when both are present.

Methods. We updated the Agency for Healthcare Research and Quality's 2012 systematic review with new literature searches in MEDLINE®, the Cochrane Central Trials Registry, the Cochrane Database of Systematic Reviews, and Embase® from 2011 through December 4, 2017. We included UI outcomes (cure, improvement, satisfaction), quality of life, and adverse events. For UI outcomes, we conducted network meta-analyses, combining direct and indirect comparisons across studies. Quality of life and adverse event outcomes are narratively described.

Results. We identified 233 eligible studies, of which 140 reported on UI outcomes, 96 on quality of life, and 127 on adverse events. Studies evaluated 16 categories of interventions with 53 specific interventions. Fourteen intervention categories have been evaluated for UI outcomes; all except hormones and periurethral bulking agents were more effective to achieve at least one favorable UI outcome than no treatment (variable strength of evidence [SoE]). Among 1st or 2nd line interventions for stress UI, behavioral therapy (BT, alone and in combination with hormones) was more effective than either alpha agonists or hormones to achieve cure or improvement (moderate SoE); alpha agonists were more effective than hormones to achieve improvement (moderate SoE). Among treatments used as 1st or 2nd line interventions for urgency UI, BT was significantly more effective than anticholinergics to achieve cure or improvement (high SoE). Among 3rd line interventions for stress UI, intravesical pressure release, but not periurethral bulking agents, was more effective than no treatment (variable SoE). Neuromodulation, which is commonly used for treatment of urgency UI, is more effective than no treatment of stress UI for cure, improvement, and satisfaction (high SoE). Among studies of women with only stress UI, indirect evidence suggests that intravesical pressure release is more effective to achieve improvement than combination BT and neuromodulation, and triple combination neuromodulation, hormones, and BT may be more effective than either periurethral bulking or combination neuromodulation and BT (all low SoE). Among treatments used as 3rd line interventions for urgency UI, both neuromodulation and onabotulinum toxin A (BTX) are more effective than no treatment (high SoE), and BTX may be more effective than neuromodulation to achieve cure (low SoE). BT, neuromodulation, and anticholinergics resulted in better quality of life than no treatment (low SoE). Urinary tract infections (UTIs) were reported in 11 percent of women receiving transcutaneous electrical nerve stimulation and erosion in 1.6 percent of women with the periurethral bulking agent macroplastique (low SoE). Dry mouth was the most commonly reported adverse event for the anticholinergic oxybutynin (36%) and the alpha agonist duloxetine (13%) (high SoE). BTX was associated with UTIs (36%) and urinary retention (10% to 20%) (moderate SoE). Constitutional adverse events (e.g., nausea, insomnia, fatigue) were common with duloxetine (moderate SoE).

Conclusions. Network meta-analyses demonstrated that most nonpharmacological and pharmacological interventions are more likely than no treatment to improve UI outcomes and quality of life. BT, alone or in combination with other interventions, is generally more effective than 2nd line (pharmacological) therapies alone for both stress and urgency UI. Common adverse events with pharmacological treatments include dry mouth, nausea, and fatigue. BTX is associated with urinary infections and retention. Periurethral bulking agents are associated with erosion and need for surgical removal. Large gaps remain in the literature regarding head-to-head comparisons of individual interventions.

Author/s:

Balk, Ethan, Adam, Gaelen P., Kimmel, Hannah, Rofeberg, Valerie, Saeed, Iman, Jeppson, Peter, Trikalinos, Thomas