UTI/RTI antimicrobial stewardship workflow

Pragmatic outpatient pathway for common infection visits emphasizing stewardship and safety-netting.

Medium-risk workflowLast reviewed September 4, 2026

AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.

Scope

Use for

Adult uncomplicated cystitis and common respiratory-infection stewardship; distinguish syndromes before treatment.

Not for

Separate urinary symptoms from respiratory illness; review vitals, allergy, pregnancy possibility, renal function and recent antibiotics.
Typical cystitis involves dysuria, urgency or frequency; vaginal symptoms suggest an alternative diagnosis. Confusion, cloudy urine or a positive urine test alone does not establish symptomatic UTI.

Treat these as urgent. Escalate early if concern persists or follow-up is unreliable.

Emergency assessment for sepsis features, respiratory compromise or hemodynamic instability.
Fever with flank pain, vomiting or systemic illness requires assessment for pyelonephritis; obstruction and inability to tolerate fluids increase urgency.
Pregnancy, male urinary anatomy, catheterization, childhood, significant renal disease or immunocompromise require a separate UTI pathway.

In eligible nonpregnant adults with uncomplicated cystitis, nitrofurantoin is a first-line option after renal and contraindication checks; the monohydrate/macrocrystal formulation is typically given for 5 days. Nitrofurantoin is unsuitable for suspected upper-tract infection.
Obtain urine culture for complicated, atypical, recurrent or nonresolving infection; routine culture is usually unnecessary for a first typical uncomplicated episode.
Avoid treating asymptomatic bacteriuria except in pregnancy or before urological procedures involving mucosal trauma.
Common cold and uncomplicated acute bronchitis usually need symptom care without antibiotics. Evaluate suspected pneumonia; use syndrome-specific guidance for bacterial RTIs.
Steroid bursts are not routine treatment for acute cough without an underlying airway indication. Record indication, regimen, stop date and review plan for every antibiotic.

Reassess UTI symptoms that fail to begin improving within 48-72 hours, or sooner for fever, flank pain or decline; review culture results when obtained.
Explain expected respiratory symptom duration and return for worsening breathing, chest pain, dehydration or systemic illness.

Return precautions you can say as written:

“If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.”

Point to the red flags above that apply to this patient.
Confirm follow-up timing and where to go after hours.
Attach a relevant handout to reinforce the plan.
Document disposition, rationale, unresolved uncertainty, and that precautions were understood.

Clinical owner: Family Medicine Editorial Team
Risk tier: Medium
Review cadence: Every 6 months
Last reviewed: September 4, 2026AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.
Review status: Evidence current. Next review due March 4, 2027.