Free Module 3 · Urinary tract infections

Rational use of antibiotics

Author and medical review: Dr. Leonardo Romeo, urologist (physician) · Last updated:

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Introduction

One of the most important topics in the module Knowing how to diagnose a urinary tract infection is not enough: you also have to know how to treat it rationally, without generating unnecessary resistance.
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Video lesson

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Video pending upload (embedded YouTube)
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Summary

What does antimicrobial stewardship mean?

It is the responsible use of antimicrobials: the right antibiotic, at the right dose, by the right route and for the right duration — no more, no less.

The 6 steps a student should learn

  1. Does the patient really have a urinary tract infection?
  2. Is it a localized or systemic UTI?
  3. Are there signs of sepsis?
  4. Is there a urologic factor (obstruction, stones, catheter) that also needs to be addressed?
  5. What tests do I need before deciding on treatment (urine culture, blood cultures, imaging)?
  6. What is the most appropriate antibiotic, with the narrowest possible spectrum?

De-escalate

Once the culture result is available, narrow the antibiotic spectrum if possible.

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PDF

⬇ Download module guide (PDF)

Urinary tract infections — Guide for Medicine: uncomplicated and complicated UTI, pyelonephritis, prostatitis, epididymitis/orchitis, urethritis and STIs, urine culture interpretation, and rational antibiotic use (all 8 topics of the module in a single document).

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Practical algorithm

Patient with urinary symptoms
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Does the patient have fever, chills, flank pain, perineal pain or general deterioration?
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NO
Localized UTI (cystitis, urethritis, mild prostatitis, etc.)
YES
Systemic UTI (pyelonephritis, severe acute prostatitis, urosepsis)
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Are there signs of sepsis?
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Is there urinary obstruction?
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Does the patient need a urine culture, blood cultures or imaging before deciding?
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Appropriate antibiotic + treatment of the urologic factor when applicable
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Clinical case

Content pending upload Progressive presentation of the case — the student makes decisions as it unfolds.
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Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

🔴 Five concepts you can't forget

  1. Not every bacteriuria should be treated: asymptomatic bacteriuria, in general, should not.
  2. Fever and flank pain make the difference between localized and systemic UTI.
  3. Obstruction + infection is a urologic emergency: it requires drainage, not just an antibiotic.
  4. An antibiogram is not read by the S/I/R letter alone: consider the clinical picture, the route and tissue penetration.
  5. Whenever possible, de-escalate the antibiotic spectrum once the culture is known.
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References

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