Telemedicine UTI Protocol

🎓 Patient Eligibility

Inclusion Criteria:

• Adult women (age 18–65)
• Classic symptoms: dysuria, urinary frequency, urgency, suprapubic discomfort
• No vaginal discharge or irritation
• No fever (>99.9°F/37.7°C), flank pain, or systemic symptoms

Exclusion Criteria:

• Pregnant women
• Men
• Immunocompromised patients
• Known urologic abnormalities (e.g., neurogenic bladder, stones)
• Indwelling catheters
• Recent urologic procedure
• Symptoms suggestive of pyelonephritis (fever, chills, flank pain, nausea/vomiting)
• Recurrent UTI (>3/year)
• Recent antibiotic use (within 4 weeks)
• Allergy to first-line antibiotics

⌛ History Taking (via Telemedicine)

• Onset, duration, and severity of symptoms
• Presence of dysuria, frequency, urgency, hematuria, suprapubic pain
• Absence of vaginal symptoms (discharge, irritation)
• Fever, chills, back/flank pain, nausea/vomiting
• Sexual history, contraception, last menstrual period (if relevant)
• Past UTI history, prior antibiotic use, allergies
• Comorbidities (diabetes, immunosuppression, renal disease)
• Pregnancy status

✍🏼 Assessment

• If classic lower urinary tract symptoms are present and no exclusion criteria, proceed with empiric treatment.
• If symptoms are atypical or exclusion criteria are met, recommend in-person evaluation and/or urinalysis/culture.

💼 Management

First-Line Empiric Therapy (Uncomplicated Cystitis):

• Nitrofurantoin 100 mg PO BID x 5 days (avoid if CrCl <30 mL/min)
• Trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg PO BID x 3 days (if local resistance <20% and no allergy)
• Fosfomycin 3 g PO single dose (less preferred due to lower efficacy)

Alternatives (if above contraindicated):

• Beta-lactams (e.g., amoxicillin-clavulanate, cefdinir) x 5–7 days (less preferred due to lower efficacy)

Symptomatic Relief:

• Phenazopyridine 200 mg PO TID x 2 days (optional, for dysuria)

🚩 Follow-Up and Red Flags

• Advise patient to follow up if:
  • Symptoms persist >48–72 hours after starting antibiotics
  • Develops fever, flank pain, nausea/vomiting
  • Allergic reaction to medication
• If symptoms worsen or pyelonephritis suspected, refer for in-person evaluation and possible urine culture.

📄 Documentation

• Document all history, assessment, rationale for telemedicine management, antibiotic choice, and patient education.
• If UTI is recurrent or complicated, recommend urine culture and/or referral.

✨ Special Considerations

• For patients with recurrent UTIs, consider further workup and urology referral.
• For postmenopausal women, consider vaginal estrogen if recurrent UTIs.

⚠️ Note: This protocol is for uncomplicated cystitis in non-pregnant adult women.