Patient handout

Complicated UTI (men, pregnant, catheter, anatomic, IC, ESBL/MDR, fungal, prostatitis overlay)

PRODUCTION

1. Your condition

This handout is for complicated uti (men, pregnant, catheter, anatomic, ic, esbl/mdr, fungal, prostatitis overlay). Your care team identified this based on: dysuria / frequency / urgency + complicating factor (man, pregnant, catheter, ic, anatomic anomaly) (idsa 2010 gupta pmid 21292654).

Other reasons your team may use this plan: adult male with uti — always complicated (idsa 2010); pregnancy + uti or asb — treat (uspstf 2019); catheter-associated uti (cauti) with symptoms (idsa 2019 pmid 20175247).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
cefpodoxime	100 mg PO BID	PO	BID × 7–14 days	IDSA 2010 first-line PO cephalosporin for complicated UTI; pregnancy-friendly (Gupta PMID 21292654)
cefdinir	300 mg PO BID	PO	BID × 7–14 days	PO cephalosporin alternative; warn about red-stool with iron-fortified foods
cephalexin	500 mg PO QID	PO	QID × 7–14 days	Pregnancy-safe; Staphylococcus saprophyticus coverage; QID dosing burden

Plan: Complicated UTI — empiric outpatient cephalosporin + men FQ + pregnancy cephalosporin + ESBL ertapenem + candiduria fluconazole + prostatitis 4–6 wk FQ

3. When to call your provider

Contact your care team if any of the following happen:

Treatment failure at 48–72 h → admit (IDSA 2010)
Fever / flank pain → ED pyelo pathway (IDSA 2010)
Sepsis screen positive → ED (SCC 2026)
Recurrent breakthrough on prophylaxis → urology (AUA 2022)
Pregnancy + worsening → OB + admit (USPSTF 2019)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

SOT, hematologic malignancy, HIV with low CD4, chronic high-dose steroid — broader empirics + ID consult low threshold (IDSA 2010)
Prior ESBL E. coli / Klebsiella culture OR current ESBL OR CRE → tailored per culture; ertapenem first for ESBL; ID consult for CRE (Tamma IDSA 2020 PMID 33106864)

5. Follow-up

Urology if anatomic / recurrent / men; prophylaxis discussion if recurrent; counsel prostatitis recurrence in men; remove catheter when possible (AUA 2022; IDSA 2019)

6. Sources

Guideline: IDSA 2011 Acute Uncomplicated Cystitis/Pyelonephritis (Gupta) + IDSA 2010 CAUTI (Hooton) + IDSA Asymptomatic Bacteriuria 2019 (Nicolle) + IDSA 2020 MDR-GNB ESBL/CRE (Tamma) + IDSA Candidiasis 2016 (Pappas — candiduria) + Hooton NEJM 2012 UTI review