Guides MDFR

Urology

Cloudy or foul-smelling urine is not UTI. Do not treat asymptomatic bacteriuria except as below.

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  • INESSS Institut national d'excellence en santé et services sociaux
  • CTFPHC Canadian Task Force on Preventive Health Care
DecisionGuideline
Nitrofurantoin and fosfomycin not for pyelo
Do not use for pyelonephritis Nitrofurantoin and fosfomycin do not achieve adequate tissue levels.

INESSS UTI GUO Dec 2023

Fluoroquinolone not first-line cystitis in women
Reserve fluoroquinolone
  • Fluoroquinolone (ciprofloxacin, etc.) not first-line for uncomplicated cystitis in women.
  • Use for complicated UTI or pyelonephritis when indicated.

INESSS UTI GUO Dec 2023

Cloudy or foul urine is not UTI
Do not treat on appearance alone Cloudy or foul-smelling urine without symptoms is not urinary tract infection.
  • Do not treat asymptomatic bacteriuria except as above (procedure, pregnancy).

INESSS UTI GUO Dec 2023 opens in a new tabCTFPHC ASB 2018 opens in a new tab

Screening

Earned

Asymptomatic bacteriuria (ASB) screening is restricted.

  • INESSS Institut national d'excellence en santé et services sociaux
  • CTFPHC Canadian Task Force on Preventive Health Care
DecisionGuideline
Do not screen except
Two indications only Do not screen for asymptomatic bacteriuria except: (1) before urologic procedure with mucosal trauma expected, (2) pregnancy.

INESSS UTI GUO Dec 2023 opens in a new tabCTFPHC ASB 2018 opens in a new tab

Pregnancy screening
Screen once first trimester Urine culture.
  • Do not repeat if negative and no symptoms.
  • INESSS UTI GUO Dec 2023 age ≥14, pregnancy out of scope.

CTFPHC ASB 2018 opens in a new tabQuébec · GUO silent

Diagnose

Age ≥14

INESSS UTI GUO Dec 2023 age ≥14. Not pregnancy, not parenteral. No pediatric GUO.

  • INESSS Institut national d'excellence en santé et services sociaux
DecisionGuideline
Cystitis (uncomplicated)
Dysuria, frequency, urgency Suprapubic discomfort.
  • No fever, no flank pain, no systemic symptoms.
  • Non-pregnant woman, no complicating factors.

INESSS UTI GUO Dec 2023 opens in a new tab

Complicated UTI
Men, pregnancy, anatomic/functional abnormality, immunocompromised, catheter, recent instrumentation Open official first-line tables.

INESSS UTI GUO Dec 2023

Treat

First-line regimens

INESSS oral tables, age ≥14. Alternative if all first-line are contraindicated, local resistance, or after the antibiogram. Second-line after failure. Open the GUO for renal adjustment, breastfeeding, and allergy. To reassess a penicillin label, see Penicillin allergy.

Oral treatment of acute cystitis in women
DrugDoseUncomplicatedComplicated
First-line
Nitrofurantoin monohydrate/macrocrystals100 mg PO BID5 days7 days (7–10)
Nitrofurantoin macrocrystals50 mg PO QID5 days7 days (7–10)
TMP-SMX160/800 mg PO BID3 days7 days (7–10)
Fosfomycin3 g PO1 dose3 doses, 48 h apart
Alternative
Amox-clav 7:1875/125 mg PO BID5 days (5–7)7 days (7–10)
Cefadroxil500 mg PO BID5 days (5–7)7 days (7–10)
Cefixime400 mg PO DIE5 days (5–7)7 days (7–10)
Second-line
Ciprofloxacin250 mg PO BID3 days5 days (5–7)
Ciprofloxacin XL500 mg PO DIE3 days5 days (5–7)
Levofloxacin250 mg PO DIE3 days5 days (5–7)
Oral treatment of acute cystitis in men
DrugDoseDuration
First-line
TMP-SMX160/800 mg PO BID7 days (7–10)
Ciprofloxacin500 mg PO BID7 days (7–10)
Ciprofloxacin XL1000 mg PO DIE7 days (7–10)
Levofloxacin500 mg PO DIE7 days (7–10)
Alternative
Nitrofurantoin monohydrate/macrocrystals100 mg PO BID7 days (7–10)
Fosfomycin3 g PO3 doses, 48–72 h apart
Amox-clav 7:1875/125 mg PO BID7 days (7–10)
Cefadroxil500 mg PO BID7 days (7–10)
Cefixime400 mg PO DIE7 days (7–10)
Oral treatment of pyelonephritis
DrugDoseWomanMan
First-line
TMP-SMX160/800 mg PO BID10 days (7–14)10 days (7–14)
Ciprofloxacin500 mg PO BID7 days (7–10)10 days (7–14)
Ciprofloxacin XL1000 mg PO DIE7 days (7–10)10 days (7–14)
Levofloxacin500 mg PO DIE7 days (7–10)10 days (7–14)
Alternative
Amox-clav 7:1875/125 mg PO BID10 days (10–14)10 days (10–14)
Cefadroxil500 mg PO BID10 days (10–14)10 days (10–14)
Cefixime400 mg PO DIE10 days (10–14)10 days (10–14)

Follow-up

  • INESSS Institut national d'excellence en santé et services sociaux
DecisionGuideline
Repeat culture
A urine culture is not recommended as a control or as a routine test (for example monthly), except when the clinical course is unfavorable (symptoms persist or return quickly after treatment).

INESSS UTI GUO Dec 2023 opens in a new tab

Reassess
Reassessment is required if there is no improvement or if symptoms worsen despite treatment, or if symptoms return quickly (2 to 4 weeks after the initial treatment).

INESSS UTI GUO Dec 2023 opens in a new tab

Pyelonephritis
When treating pyelonephritis orally, systematically reassess the person at 72 h post-treatment.

INESSS UTI GUO Dec 2023 opens in a new tab

Prophylaxis
When antibiotic prophylaxis is given to prevent urinary tract infections, follow-up is advised after 3 to 6 months to assess the efficacy and safety of the prophylaxis and to discuss continuing, stopping, or changing the prophylaxis strategy.

INESSS UTI GUO Dec 2023 opens in a new tab

Reviewed 31 August 2026 against the official sources below.

Sources

Blue square: Québec · red round: Canada. The code names the body; each section's key gives its full name.

INESSS UTI GUO Dec 2023 opens in a new tab
CTFPHC Asymptomatic bacteriuria 2018 opens in a new tab