Females/Healthy Males - First episode

- Screen for pyuria. A negative urinalysis/microscopy for pyuria excludes UTI in most cases.

- Pre-treatment urine culture recommended if:

  • quinolone or cephalosporin use within last 6 months

  • previous UTI with Gram negative organism other than E. coli, or with an ESBL or AmpC-producing organism

  • travel outside Canada/U.S. within last 6 months

  • recent hospitalization/health care associated

  • complicated UTI.

- Routine post treatment urine cultures are not recommended if pyuria, typical symptoms of cystitis and adequate response to therapy.

- Lack of response after 48h of appropriate antibiotic therapy warrants:

  • urine culture (if not taken pre-treatment),

  • treatment for pyelonephritis tailored to C&S results if available, and

  • clinical evaluation for other genitourinary infections, including sexually transmitted infections (STIs).

Usual Pathogens

E. coli
S. saprophyticus
Other Enterobacterales
Organisms that are NOT usual uropathogens in uncomplicated cystitis


Empiric Therapy Dose Duration
Nitrofurantoin Macrobid 100mg PO bid  or 5 days
  50-100mg PO qid 5 days
Alternative if creatinine clearance <40 mL/min or intolerance/allergy to nitrofurantoin    
Fosfomycin 3g PO 1 dose

Alternative for 1st time cystitis and no antibiotic exposure within last 6 months

Empiric Therapy Dose Duration
Cephalexin 250-500mg PO qid 5-7 days
TMP/SMX 1 DS tab PO bid 3 days
Ciprofloxacin 250mg PO bid or 3 days
  XL 500mg PO daily 3 days

Alternative in other patients

Empiric Therapy Dose Duration
Cefixime 400mg PO daily 5-7 days
Ciprofloxacin 250mg PO bid or 3 days
  XL 500mg PO daily 3 days