Leverage Digital Communications During UTI Care in 2026

Researchers recently developed new national guidelines for triaging adults with suspected urinary tract infections (UTIs), marking a significant update tailored to the current landscape of virtual and telehealth care.

Published in JAMA Network Open on January 29, 2026, the new study presents expert consensus on the appropriateness of empiric antibiotics, urine testing, and clinical evaluation options across various ambulatory settings.

Furthermore, two algorithms for uncomplicated UTI management were identified, one for non-pregnant women and one for men.

The new criteria consider multiple communication methods, including phone calls, patient portal messaging, real-time audio-video virtual visits, and asynchronous e-visits.

Led by researchers from the VA Ann Arbor Healthcare System and the University of Michigan Medical School, this study used the RAND/UCLA Appropriateness Method. They rated the appropriateness of 136 clinical scenarios (48 for women, 49 for men, and 39 sex-neutral), resulting in over 1,000 total ratings.

Key recommendations include: - Immediate in-person evaluation for symptoms suggestive of pyelonephritis, complicated cystitis, urinary obstruction, or non-UTI conditions (e.g., diarrhea, genital discharge, cough).

No urine testing or empiric antibiotics should be given solely for changes in urine color or appearance without classic cystitis symptoms (such as dysuria, frequency, urgency, and suprapubic pain).

For non-pregnant women with new-onset classic cystitis symptoms and no risks of antibiotic resistance (e.g., no recent UTI antibiotics or recurrent UTIs), empiric treatment without testing or a visit is appropriate in many cases.

For women with resistance risks or for all men, urinalysis with culture is recommended before starting antibiotics; urinalysis alone without culture capability was deemed inappropriate.

Empiric treatment may be considered when there are barriers to timely testing or visits (e.g., transportation issues, remote location, or lab closures).

The guidelines aim to standardize care, reduce inappropriate antibiotic prescribing amid rising antibiotic resistance, and improve patient triage, particularly in virtual settings with limited access to testing.

Jennifer Meddings, M.D., M.Sc., the first author of the paper, is a primary care clinician and patient safety researcher at the VAAAHS and Michigan Medicine, U-M's academic medical center. She stated in a press release, "Now, far fewer patients are being seen in person in a setting where a urine sample can be collected, cultured, and used by the same provider as the basis for a treatment recommendation a few days later."

Dr. Meddings added, "So it's more important than ever for providers to know which patients can safely receive antibiotics empirically – that is, without a urine culture and not just a dipstick test or no test."

For patients with frequent or complicated UTIs, clinicians may discuss off-label or travel-based access to vaccine options.

As of February 2, 2026, no UTI vaccine is approved or widely available in the United States.

The most advanced and widely discussed option remains Uromune™ (MV140), an inactivated, sublingual oral spray vaccine containing inactivated whole cells from common uropathogens (including Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, and Proteus vulgaris).

This pineapple-flavored vaccine, administered as two daily sprays under the tongue for three months, has shown promising long-term results in studies—such as keeping over 50% of recipients UTI-free for up to nine years in follow-up data.

It is commercially available through expanded access programs or approved use in approximately 20–26 countries, including the United Kingdom, where vaccine clinics are located.

However, it remains unavailable in the U.S.

The full article is available in JAMA Network Open (doi:10.1001/jamanetworkopen.2025.56135), along with supplemental materials including detailed algorithms.