Wisconsin Long-Term Care
Urinary Tract Infection Toolkit

Module 4: When & How to Treat a UTI

This module is organized into four content sections. Each section includes a slide deck presentation. Additional links and resources are also provided. A complete reference list is included at the end of the module.

Section 1: When to Treat -+

UTI Stoplight
When to Test Nursing Tool
Active Monitoring Tracking Form

Section 2: How to Treat -+

Provider Prescribing Brochure

Section 3: Antibiotic Time Out -+


Section 4: Collaborative Role of the Pharmacist -+

Sample CPA Agreement
Sample CPA Policy
Sample CPA Cover Letter

Additional Resources -+

University of Nebraska Urinary Tract Infection and Asymptomatic Bacteriuria Guidance This resource developed by the University of Nebraska Antimicrobial Stewardship Program provides useful information on the selection of antibiotics in patients experiencing a complicated urinary tract infection.

Johns Hopkins ABX Guide: Urinary Tract Infection, Complicated (UTI) This links to recommendations for the treatment of complicated UTI (requires a paid subscription).

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Glomerular Filtration Rate (GFR) Calculator A freely available online GFR calculator that includes adjustment for race and gender. This calculator otherwise only requires resident serum creatinine (mg/dL) and age. A recent weight is not required to provide an estimated GFR.

Cockcroft-Gault Creatinine Clearance Equation (MDCalc) This freely available online calculator that estimates an individual’s creatinine clearance based on their gender, age, weight and serum creatinine (mg/mL).

Reference List-+

  1. Crnich CJ, Drinka, PJ. Improving the Management of Urinary Tract Infections in Nursing Homes: It’s Time to Stop the Tail From Wagging the Dog. Ann Long Term Care 2014;22(9):32-6.
  2. Nace DA, Drinka PJ, Crnich CJ. Clinical Uncertainties in the Approach to Long Term Care Residents with Possible Urinary Tract Infection. J Am Med Dir Assoc 2014;15(2):133-9. PMID: 2446120.
  3. Brown KA, Khanafer N, Daneman N, Fisman DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother 2013 May;57(5):2326-32. doi: 10.1128/AAC.02176-12. PMID: 23478961.
  4. Tandan M, Cormican M, Vellinga A. Adverse events of fluoroquinolones vs. other antimicrobials prescribed in primary care: A systematic review and meta-analysis of randomized controlled trials. Int J Antimicrob Agents 2018;52:529-40. doi: 10.1016/j.ijantimicag.2018.04.014.
  5. Daneman N, Lu H, Redelmeier DA. Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study. BMJ Open 2015 Nov 18;5(11):e010077. doi: 10.1136/bmjopen-2015-010077. PMID: 26582407.
  6. FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together.
  7. Drekonja DM, Rector TS, Cutting A, Johnson JR. Urinary tract infection in male veterans: treatment patterns and outcomes. JAMA Intern Med 2013 Jan 14;173(1):62-8. doi: 10.1001/2013.jamainternmed.829. PMID: 23212273.
  8. Nace DA, Perera SK, Hanlon JT, Saracco S, Anderson G, Schweon SJ, Klein-Fedyshin M, Wessel CB, Mulligan M, Drinka PJ, Crnich CJ. The Improving Outcomes of UTI Management in Long-Term Care Project (IOU) Consensus Guidelines for the Diagnosis of Uncomplicated Cystitis in Nursing Home Residents. J Am Med Dir Assoc 2018 Sep;19(9):765-769.e3. doi: 10.1016/j.jamda.2018.05.030. PMID: 30037743.
  9. Hanlon JT, Perera S, Drinka PJ, Crnich CJ, Schweon SJ, Klein-Fedyshin M, Wessel CB, Saracco S, Anderson G, Mulligan M, Nace DA. The IOU Consensus Recommendations for Empirical Therapy of Cystitis in Nursing Home Residents. J Am Geriatr Soc 2019 Mar;67(3):539-545. doi: 10.1111/jgs.15726. PMID: 30584657.
  10. University of Nebraska-Urinary Tract Infection and Asymptomatic Bacteriuria Guideline.
  11. Gupta K, Hooton TM, Miller L; Uncomplicated UTI IDSA Guideline Committee. Managing uncomplicated urinary tract infection--making sense out of resistance data. Clin Infect Dis 2011 Nov;53(10):1041-2. doi: 10.1093/cid/cir637. PMID: 21940416.
  12. Hossin T, Bahranian M, Taylor L, Nace D, Crnich CJ. Estimating the impact of post-prescribing review on the quality of antibiotic prescribing in skilled nursing facilities. Open Forum Infect Dis 2017; 4(Suppl 1): S160.
  13. Lee TC, Frenette C, Jayaraman D, Green L, Pilote L. Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve antimicrobial use. Ann Intern Med 2014 Nov 18;161(10 Suppl):S53-8. doi: 10.7326/M13-3016. PMID: 25402404.
  14. Jones M, Butler J, Graber CJ, Glassman P, Samore MH, Pollack LA, Weir C, Goetz MB. Think twice: A cognitive perspective of an antibiotic timeout intervention to improve antibiotic use. J Biomed Inform 2017 Jul;71S:S22-S31. doi:10.1016/j.jbi.2016.06.005. PMID: 27327529.
  15. CDC Core Elements of Antibiotic Stewardship in Nursing Homes
  16. 2013 Wisconsin Act 294