{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:51:53Z","timestamp":1792601513411,"version":"4.5.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"Supplement_3","license":[{"start":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T00:00:00Z","timestamp":1766188800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>These recommendations provide guidance on the optimal duration of antibiotics in patients with complicated urinary tract infection (cUTI), especially in presence of associated Gram-negative bacteremia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The panel's recommendations are based upon evidence derived from systematic literature reviews which focused on comparative benefits and harms of shorter (5\u20137 days) vs prolonged (10\u201314 days) duration of antibiotics, including publications since 2000. These recommendations adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The guidelines panel suggests that patients with cUTI who are improving on effective therapy can be treated with shorter duration of antimicrobials (either 5\u20137 days of a fluoroquinolone or 7 days of a non-fluoroquinolone) rather than longer courses of antibiotics, regardless of the presence of associated Gram-negative bacteremia. An effective antimicrobial agent achieves therapeutic levels in the urine and relevant tissue and is active against the causative pathogen. However, men with febrile UTI in whom acute bacterial prostatitis is suspected may benefit from a longer treatment duration (10\u201314 days), and a short courses of oral beta lactams may require higher doses for efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Shorter durations of antibiotics for cUTI provide similar efficacy as longer courses, except in men with febrile UTI in whom acute bacterial prostatitis is suspected. This recommendation places a high value on antibiotic stewardship considerations as well as reducing the burden of antimicrobial administration from a healthcare perspective and reducing the burden of taking antibiotics from a patient perspective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf462","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:05:32Z","timestamp":1765458332000},"page":"i79-i88","source":"Crossref","is-referenced-by-count":25,"title":["Clinical Practice Guidelines by Infectious Diseases Society of America (IDSA): 2025 Guidelines on Management and Treatment of Complicated Urinary Tract Infections--Duration of Antibiotics for Complicated UTI"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7986-9099","authenticated-orcid":false,"given":"Barbara W","family":"Trautner","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine , St. Louis, MO ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00e1s W","family":"Cort\u00e9s-Penfield","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of Nebraska Medical Center , Omaha, NE ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalpana","family":"Gupta","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Boston VA Health Care System, Boston University School of Medicine , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth B","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy , Minneapolis, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Horstman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Baylor College of Medicine , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J","family":"Moran","sequence":"additional","affiliation":[{"name":"Clinical Emergency Medicine, David Geffen School of Medicine at UCLA, Olive View-UCLA Medical Center , Los Angeles, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Colgan","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Maryland School of Medicine , Baltimore, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C","family":"O\u2019Horo","sequence":"additional","affiliation":[{"name":"Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad S","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center , Omaha, NE ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Connolly","sequence":"additional","affiliation":[{"name":"Planned Parenthood of Orange and San Bernardino Counties , Orange, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri","family":"Drekonja","sequence":"additional","affiliation":[{"name":"Infectious Disease Section, Minneapolis VA Health Care System, University of Minnesota Medical School , Minneapolis, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3420-2623","authenticated-orcid":false,"given":"Larissa","family":"Grigoryan","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Baylor College of Medicine , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Huttner","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gweneth B","family":"Lazenby","sequence":"additional","affiliation":[{"name":"Departments of Obstetrics and Gynecology and Medicine Division of Infectious Diseases, Medical University of South Carolina , Charleston, SC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Nicolle","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Manitoba School of Medicine , Winnipeg, MB ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1324-3517","authenticated-orcid":false,"given":"Anthony","family":"Schaeffer","sequence":"additional","affiliation":[{"name":"Department of Urology, Feinberg School of Medicine Northwestern University , Chicago, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigal","family":"Yawetz","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Brigham and Women's Hospital , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9ry","family":"Lavergne","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Division of Medical Microbiology and Infection Control, Vancouver General Hospital, University of British Columbia , Vancouver, BC ,","place":["Canada"]},{"name":"Department of Clinical Affairs and Practice Guidelines, Infectious Diseases Society of America (IDSA) , Arlington, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,20]]},"reference":[{"key":"2026082412171763200_ciaf462-B1","doi-asserted-by":"crossref","first-page":"103566","DOI":"10.1016\/j.ebiom.2021.103566","article-title":"Effects of antibiotic duration on the intestinal microbiota and resistome: the PIRATE RESISTANCE project, a cohort study nested within a randomized trial","volume":"71","author":"Leo","year":"2021","journal-title":"EBioMedicine"},{"key":"2026082412171763200_ciaf462-B2","author":"Federal Task Force on Combating Antibiotic-Resistant Bacteria"},{"key":"2026082412171763200_ciaf462-B3","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.cmi.2021.10.022","article-title":"Estimating daily antibiotic harms: an umbrella review with individual study meta-analysis","volume":"28","author":"Curran","year":"2022","journal-title":"Clin Microbiol Infect"},{"key":"2026082412171763200_ciaf462-B4","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1001\/jamainternmed.2017.1938","article-title":"Association of adverse events with antibiotic use in hospitalized patients","volume":"177","author":"Tamma","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2026082412171763200_ciaf462-B5","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1001\/jamasurg.2019.0569","article-title":"Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events","volume":"154","author":"Branch-Elliman","year":"2019","journal-title":"JAMA Surg"},{"key":"2026082412171763200_ciaf462-B6","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1093\/cid\/ciw118","article-title":"Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the society for Healthcare Epidemiology of America","volume":"62","author":"Barlam","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2026082412171763200_ciaf462-B7","author":"Centers for Disease Control and Prevention"},{"key":"2026082412171763200_ciaf462-B8","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.apmr.2013.09.003","article-title":"Short versus long course of antibiotics for catheter-associated urinary tract infections in patients with spinal cord injury: a randomized controlled noninferiority trial","volume":"95","author":"Darouiche","year":"2014","journal-title":"Arch Phys Med Rehabil"},{"key":"2026082412171763200_ciaf462-B9","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.urology.2007.09.002","article-title":"A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400\/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis","volume":"71","author":"Peterson","year":"2008","journal-title":"Urology"},{"key":"2026082412171763200_ciaf462-B10","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1001\/jama.283.12.1583","article-title":"Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial","volume":"283","author":"Talan","year":"2000","journal-title":"JAMA"},{"key":"2026082412171763200_ciaf462-B11","doi-asserted-by":"crossref","first-page":"2154","DOI":"10.1093\/cid\/ciad070","article-title":"Antimicrobial for 7 or 14 days for febrile urinary tract infection in men: a multicenter noninferiority double-blind, placebo-controlled, randomized clinical trial","volume":"76","author":"Lafaurie","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2026082412171763200_ciaf462-B12","doi-asserted-by":"crossref","first-page":"e02317-17","DOI":"10.1128\/AAC.02317-17","article-title":"Explorative randomized phase II clinical study of the efficacy and safety of finafloxacin versus ciprofloxacin for treatment of complicated urinary tract infections","volume":"62","author":"Wagenlehner","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"key":"2026082412171763200_ciaf462-B13","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s12916-017-0835-3","article-title":"Treatment duration of febrile urinary tract infection: a pragmatic randomized, double-blind, placebo-controlled non-inferiority trial in men and women","volume":"15","author":"van Nieuwkoop","year":"2017","journal-title":"BMC Med"},{"key":"2026082412171763200_ciaf462-B14","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/S0140-6736(12)60608-4","article-title":"Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial","volume":"380","author":"Sandberg","year":"2012","journal-title":"Lancet"},{"key":"2026082412171763200_ciaf462-B15","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1007\/s10096-017-2951-6","article-title":"Is 5 days of oral fluoroquinolone enough for acute uncomplicated pyelonephritis? The DTP randomized trial","volume":"36","author":"Dinh","year":"2017","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2026082412171763200_ciaf462-B16","doi-asserted-by":"crossref","first-page":"e0197302","DOI":"10.1371\/journal.pone.0197302","article-title":"Stopping the effective non-fluoroquinolone antibiotics at day 7 vs continuing until day 14 in adults with acute pyelonephritis requiring hospitalization: a randomized non-inferiority trial","volume":"13","author":"Rudrabhatla","year":"2018","journal-title":"PLoS One"},{"key":"2026082412171763200_ciaf462-B17","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1007\/s11255-017-1507-0","article-title":"Treatment of complicated urinary tract infection and acute pyelonephritis by short-course intravenous levofloxacin (750 mg\/day) or conventional intravenous\/oral levofloxacin (500\u2005mg\/day): prospective, open-label, randomized, controlled, multicenter, non-inferiority clinical trial","volume":"49","author":"Ren","year":"2017","journal-title":"Int Urol Nephrol"},{"key":"2026082412171763200_ciaf462-B18","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1001\/jama.2012.80","article-title":"Cefpodoxime vs ciprofloxacin for short-course treatment of acute uncomplicated cystitis: a randomized trial","volume":"307","author":"Hooton","year":"2012","journal-title":"JAMA"},{"key":"2026082412171763200_ciaf462-B19","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1001\/jama.1995.03520250057034","article-title":"Randomized comparative trial and cost analysis of 3-day antimicrobial regimens for treatment of acute cystitis in women","volume":"273","author":"Hooton","year":"1995","journal-title":"JAMA"},{"key":"2026082412171763200_ciaf462-B20","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1093\/cid\/ciad009","article-title":"Defining the optimal duration of therapy for hospitalized patients with complicated urinary tract infections and associated bacteremia","volume":"76","author":"McAteer","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2026082412171763200_ciaf462-B21","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1093\/ajhp\/zxac202","article-title":"Oral beta-lactams vs fluoroquinolones and trimethoprim\/sulfamethoxazole for step-down therapy for Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae bacteremia","volume":"80","author":"McAlister","year":"2023","journal-title":"Am J Health Syst Pharm"},{"key":"2026082412171763200_ciaf462-B22","doi-asserted-by":"crossref","first-page":"e148","DOI":"10.1017\/ash.2023.435","article-title":"Outcomes of high-dose oral beta-lactam definitive therapy compared to fluoroquinolone or trimethoprim-sulfamethoxazole oral therapy for bacteremia secondary to a urinary tract infection","volume":"3","author":"Geyer","year":"2023","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"key":"2026082412171763200_ciaf462-B23","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1093\/jac\/dkt177","article-title":"Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection\u2013 7 days or less versus longer treatment: systematic review and meta-analysis of randomized controlled trials","volume":"68","author":"Eliakim-Raz","year":"2013","journal-title":"J Antimicrob Chemother"},{"key":"2026082412171763200_ciaf462-B24","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1093\/cid\/ciy1054","article-title":"Seven versus 14 days of antibiotic therapy for uncomplicated gram-negative bacteremia: a noninferiority randomized controlled trial","volume":"69","author":"Yahav","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2026082412171763200_ciaf462-B25","doi-asserted-by":"crossref","first-page":"2160","DOI":"10.1001\/jama.2020.6348","article-title":"Effect of C-reactive protein-guided antibiotic treatment duration, 7-day treatment, or 14-day treatment on 30-day clinical failure rate in patients with uncomplicated gram-negative bacteremia: a randomized clinical trial","volume":"323","author":"von Dach","year":"2020","journal-title":"JAMA"},{"key":"2026082412171763200_ciaf462-B26","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.cmi.2021.09.001","article-title":"Seven-versus 14-day course of antibiotics for the treatment of bloodstream infections by Enterobacterales: a randomized, controlled trial","volume":"28","author":"Molina","year":"2022","journal-title":"Clin Microbiol Infect"},{"key":"2026082412171763200_ciaf462-B27","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1093\/cid\/ciz393","article-title":"Reply to De Greef et al","volume":"70","author":"Yahav","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2026082412171763200_ciaf462-B28","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1056\/NEJMoa2404991","article-title":"Antibiotic treatment for 7 versus 14 days in patients with bloodstream infections","volume":"392","author":"BALANCE Investigators, for the Canadian Critical Care Trials Group","year":"2025","journal-title":"N Engl J Med"},{"key":"2026082412171763200_ciaf462-B29","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s00345-020-03261-5","article-title":"National trends in the use of PSA, urinalysis, and digital rectal exam for evaluation of lower urinary tract symptoms in men","volume":"39","author":"Doolin","year":"2021","journal-title":"World J Urol"},{"key":"2026082412171763200_ciaf462-B30","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1046\/j.1464-410x.1999.00164.x","article-title":"Prostatic involvement in men with febrile urinary tract infection as measured by serum prostate-specific antigen and transrectal ultrasonography","volume":"84","author":"Ulleryd","year":"1999","journal-title":"BJU Int"},{"key":"2026082412171763200_ciaf462-B31","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1001\/jamainternmed.2016.3646","article-title":"The new antibiotic mantra-\u201cshorter is better\u201d","volume":"176","author":"Spellberg","year":"2016","journal-title":"JAMA Intern Med"},{"key":"2026082412171763200_ciaf462-B32","doi-asserted-by":"crossref","first-page":"e105454","DOI":"10.1371\/journal.pone.0105454","article-title":"The magnitude and duration of Clostridium difficile infection risk associated with antibiotic therapy: a hospital cohort study","volume":"9","author":"Brown","year":"2014","journal-title":"PLoS One"},{"key":"2026082412171763200_ciaf462-B33","doi-asserted-by":"crossref","first-page":"ofac706","DOI":"10.1093\/ofid\/ofac706","article-title":"Can the future of ID escape the inertial dogma of its past? The exemplars of shorter is better and oral is the new IV","volume":"10","author":"Davar","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"2026082412171763200_ciaf462-B34","doi-asserted-by":"crossref","first-page":"257","DOI":"10.7326\/M19-0505","article-title":"Use of antibiotics without a prescription in the U.S. population: a scoping review","volume":"171","author":"Grigoryan","year":"2019","journal-title":"Ann Intern Med"},{"key":"2026082412171763200_ciaf462-B35","doi-asserted-by":"crossref","first-page":"e257","DOI":"10.1097\/pq9.0000000000000257","article-title":"Decreasing the duration of discharge antibiotic treatment following inpatient skin and soft tissue abscess drainage","volume":"5","author":"Erdem","year":"2020","journal-title":"Pediatr Qual Saf"},{"key":"2026082412171763200_ciaf462-B36","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1093\/jac\/dkm313","article-title":"Costs associated with shorter duration of antibiotic therapy in hospitalized patients with mild-to-moderate severe community-acquired pneumonia","volume":"60","author":"Opmeer","year":"2007","journal-title":"J Antimicrob Chemother"},{"key":"2026082412171763200_ciaf462-B37","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1086\/380964","article-title":"Long-term antibiotic cost savings from a comprehensive intervention program in a medical department of a university-affiliated teaching hospital","volume":"38","author":"R\u00fcttimann","year":"2004","journal-title":"Clin Infect Dis"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaf462\/66039695\/ciaf462.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/82\/Supplement_3\/i79\/66039695\/ciaf462.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/82\/Supplement_3\/i79\/66039695\/ciaf462.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:17:26Z","timestamp":1787588246000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/82\/Supplement_3\/i79\/8384478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,20]]},"references-count":37,"journal-issue":{"issue":"Supplement_3","published-online":{"date-parts":[[2025,12,20]]},"published-print":{"date-parts":[[2026,8,24]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaf462","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4,15]]},"published":{"date-parts":[[2025,12,20]]}}}