Urinary Tract Infection

[2011 Update]

Introduction to this self-study CME activity


Urinary tract infection (UTI) has a high incidence in adult women. It is often not managed cost effectively, with laboratory tests performed that do not affect the management or outcome of treatment. This self-study activity provides practical guidance to primary care clinicians regarding the diagnosis and treatment of UTI and how to implement a cost-effective management strategy for uncomplicated UTI in women.  Key aspects of care include:

  • Pretreatment cultures are rarely necessary for uncomplicated UTI.
  • Consider telephone management for uncomplicated UTI in women with previous UTI.
  • Despite increasing resistance patterns to trimethoprim / sulfa and ciprofloxicin, clinical response remains robust.
  • TMP/SMX or Macorbid are the recommended drugs of first choice in uncomplicated UTI in women.  Three days of treatment with Bactrim or five days of treatment with Macrobid is usually sufficient for uncomplicated UTI.  Second line therapy alternatives include three days of Cipro or seven days of Amoxacillin.
  • Follow up cultures or urinalysis are not usually necessary.

This 2011 update of the guideline also addresses the following points:

  • Escherichia coli resistance rates have continued to increase. UMHS rates of resistance to trimethoprim / sulfa = 28% and Ciprofloxicin=27%. Nitrofurantoin resistance is <5%, Amoxicillin >25%.
  • Clinical response rates continue at the 80-90% range despite the increasing bacteriologic resistance rates
  • First line therapy recommendations include both trimethoprim / sulfa and Macrobid
  • Recommending alternative forms of contraception is not necessary when prescribing antibiotics for UTI in women using oral contraceptives (OCPs)
  • Some studies have shown that cranberry juice or cranberry tablets can significantly reduce the annual incidence of UTIs in sexually active women with a history of recurrent UTIs.


Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for the diagnosis and treatment of uncomplicated UTI in adult women.


This self-study activity is appropriate for primary care clinicians and other health care providers treating adults with urinary tract infection.


Team Leaders

  • Steven E. Gradwohl MD
    General Internal Medicine

Team Members

  • Catherine M Bettcher, MD
    Family Medicine
  • Carol E Chenoweth, MD
    Infectious Diseases
  • R Van Harrison, PhD
    Medical Education
  • Lauren B Zoschnick, MD
    Obstetrics & Gynecology

Author Disclosures

Neither the team lead, the team members, nor the consultants have financial relationships with commercial companies whose products are discussed in this CME activity.

Other Acknowledgements

UMHS Guidelines Oversight Team

  • Grant M. Greenberg, MD., MA., MHSA
  • R. Van Harrison, PhD
  • Connie J. Standiford, MD

Literature Search Services

  • Taubman Medical Library

Production of Internet Format and Website Maintenance

  • Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This CME activity was released in June 2011, with credit available through May 2017. The activity was reviewed for currency of content in September 2016 and availability of credit extended through September 2019. Continuation of credit from that date depends on a thorough review of the content currency and accuracy. 

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.