New Guide Aims to Improve UTI Care in Telehealth Era

Experts create algorithm to help clinicians triage UTI cases and avoid overuse of antibiotics

Jan. 29, 2026 at 9:39pm

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Millions of Americans seek treatment for urinary tract infections (UTIs) each year, and the rise of telehealth and direct-to-consumer health services has changed how many of these cases are diagnosed and treated. To address the risks of inappropriate antibiotic prescribing and lack of urine culture testing, a team of experts has published a new guide to help clinicians triage UTI cases, especially in virtual care settings.

Why it matters

UTIs are one of the most common reasons for antibiotic prescriptions in the U.S., and overuse of antibiotics can contribute to the rise of antibiotic-resistant "superbugs." The new guide aims to provide a standardized approach to UTI diagnosis and treatment, especially as more patients seek care through telehealth services that may not involve in-person testing.

The details

The "Ann Arbor Guide to Triaging Adults with Suspected UTI" was developed by a team from the VA Ann Arbor Healthcare System and the University of Michigan Medical School. It includes algorithms to help clinicians decide when to order urine cultures, when to prescribe antibiotics empirically, and how to triage patients with more complex medical histories. The guide also cautions against relying solely on over-the-counter UTI tests, which can be inaccurate, and calls for confirmation of UTI by urine culture wherever possible.

  • The new guide was published in January 2026 in the JAMA Network Open journal.

The players

Jennifer Meddings

A primary care clinician and patient safety researcher at the VA Ann Arbor Healthcare System and Michigan Medicine, and the first author of the new guide.

Karen Fowler

A longtime patient safety specialist at the VA Center for Clinical Management Research who helped develop the new guide.

Kristin Chrouser

A urologist at the University of Michigan and the VA who co-authored the guide.

Sanjay Saint

A member of the University of Michigan Institute for Healthcare Policy and Innovation who co-directs the Patient Safety Center of Inquiry project that funded this work.

Steven Bernstein

A member of the University of Michigan Institute for Healthcare Policy and Innovation who co-authored the guide.

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What they’re saying

“Clinics have long had triage systems for uncomplicated UTIs, especially for healthy women, but then virtual care, patient portal messaging and online 'doc-in-a-box' services that deliver prescriptions to anyone who answers a questionnaire have really changed things.”

— Jennifer Meddings, Professor of Internal Medicine and Pediatrics at the University of Michigan Medical School (JAMA Network Open)

“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. 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.”

— Jennifer Meddings, Professor of Internal Medicine and Pediatrics at the University of Michigan Medical School (JAMA Network Open)

What’s next

The new guide is now being piloted for use in telehealth visits for Veterans cared for by local VA health centers. The team will assess how well providers feel the guide works for triaging patients seeking emergency and urgent care for UTI-like symptoms through virtual options.

The takeaway

This new guide aims to help both patients and providers navigate the changing landscape of UTI care, where telehealth and direct-to-consumer services have removed some barriers but also introduced new risks around inappropriate antibiotic use and lack of confirmatory testing. By providing standardized algorithms, the guide seeks to promote more evidence-based, safe, and effective UTI management, especially in virtual care settings.