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Clinician teams have developed 2 new algorithms to guide the triage and management of adults with symptoms suggestive of urinary tract infection (UTI) across care settings, including patients who present by phone, portals, virtual visits, and in-person visits. Unlike prior recommendations that were built on telephone-based triage and empiric treatment, this new guidance published in JAMA Network Open reflects the new channels patients use to seek care. They provide structured decision support for determining visit type, diagnostic testing, and antibiotic use. The algorithms are designed to help clinicians quickly identify which patients can be managed remotely, which require urine testing or empiric therapy, and which should be directed to in-person evaluation. By standardizing UTI triage decisions, the approach aims to reduce inappropriate antibiotic prescribing. A national 13-member multidisciplinary panel reviewed literature from 2009 to June 2024 and rated the appropriateness of empiric treatment, types of urine testing, and triage to visit type (in-person, virtual, or none) as: appropriate (ie, benefits outweigh risks); inappropriate; or of uncertain appropriateness. The resulting algorithms—1 for nonpregnant women and 1 for men—can be used in any setting to determine whether urine testing, empiric antibiotics, and further examination might be needed. The summary recommendations and algorithms are available for download from the publication.
Home tests: A separate press release explains that the authors also determined at-home UTI tests bought over the counter or online are not accurate enough to confirm a UTI. Because of concerns about how over-the-counter tests are performed and interpreted, the tests “were not thought to be an appropriate strategy to substitute for routine urinalysis with urine culture testing.”