Cystitis and Pyelonephritis

Cystitis and Pyelonephritis

Guideline Use

Utilize the Severe Sepsis/Septic Shock guidelines

Dose recommendations are based on patients with normal renal function. Refer to dosing in renal impairment.

These guidelines may not be appropriate for patients with a history of multi-drug resistant organisms. Consider infectious disease consultation.

Pediatric Guidelines


Altered mental status alone is NOT an indication for UA and cultures

  • Severe Sepsis/Septic Shock

  • Neutropenic Fever

  • Screening for Urologic Procedures

  • Screening in pregnancy

  • Do NOT obtain cultures unless symptomatic
  • Altered mental status ALONE is not an indication for culture
  • Fever ALONE is not an indication for culture unless catheterized and no alternative explanation

Management Considerations

Treatment of asymptomatic bacteriuria increases risk of adverse events without improving outcomes, except in specific populations:

  • Pregnancy

  • Undergoing endourological procedures

ID consultation should be considered for patients with history of recurrent UTIs or multi-drug resistant organisms

Empiric Therapy

Bacteria (≥ 105 CFU/mL or ≥ 108 CFU/L) in the urine in the absence of symptoms

  • (+) Culture + pyuria is not an indication for treatment
  • (+) Culture + nitrites are not an indication for treatment

Community onset or hospitalized < 48 hours

Hospitalized > 48 hours

Definitive Therapy

Additional Information

These recommendations are meant to guide empiric therapeutic decision making and are not meant to replace sound clinical decision making. Definitive therapy should be based on culture and susceptibility reports

  • Regina Ianni, PharmD

  • Kyle D. Massey, PharmD

  • Rebekah Gass, MD

  • Brian McCullough, PharmD

  1. Hooton et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infections in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. CID. 2010:50;625-663.
  2. Gupta et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2019 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. CID. 2011;52:e103.
  3. Nicolle et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. CID. 2019:68;e83-75.
  4. Gomila et al. Risk factors and prognosis of complicated urinary tract infections caused by pseudomonas aeruginosa in hospitalized patients: a retrospective multicenter cohort study. Infect Drg Resist. 2018;11:2571-2581.
  5. Yahav et al. Seven versus 14 days of antibiotic therapy for uncomplicated gram-negative bacteremia: a noninferiority randomized controlled trial. CID. 2019;69:1091-1098.