Released June 10, 2026

About the Webinar

The way clinicians diagnose and treat UTIs is changing, and this is your chance to get up to speed. This webinar will review the latest literature on UTI diagnosis—including pyuria thresholds and a newly established consensus definition from a Delphi study—and examine recently approved antibiotics and the data supporting their use. A live Q&A with Dr. Michael Melia will follow the presentation.

Webinar Recording

Webinar Audio

Webinar Summary

In this webinar, Dr. Melia reviewed new evidence on the diagnosis and treatment of urinary tract infections (UTIs), focusing on the clinical significance of pyuria and recently approved treatment options. Drawing on studies of both premenopausal and postmenopausal women, he emphasized that pyuria is common even in the absence of infection. Although pyuria correlates with bacteriuria, its positive predictive value is low, meaning many patients with pyuria do not have a UTI. Consequently, pyuria alone should not be used to diagnose infection or prompt antibiotic treatment. However, the absence of pyuria remains a strong indicator that a UTI is unlikely.

Dr. Melia also reviewed data suggesting that commonly used laboratory thresholds for pyuria may be too low and contribute to overdiagnosis and overtreatment. Studies in older women demonstrated that higher pyuria thresholds improve diagnostic specificity while maintaining reasonable sensitivity. He discussed a recent expert consensus effort to standardize UTI definitions, which incorporates symptoms, pyuria, urine culture results, and signs of systemic illness into a scoring framework rather than relying on a single finding.

Dr. Melia also highlighted two newer treatment options for uncomplicated cystitis. Pivmecillinam, approved in the United States in 2024 after decades of use in Europe, has demonstrated sustained low resistance rates and activity against many drug-resistant urinary pathogens. Clinical studies support its effectiveness, including shorter treatment courses. Dr. Melia also reviewed gepotidacin, a first-in-class antibiotic with a novel mechanism of action that inhibits bacterial DNA replication. Phase 3 trials showed that gepotidacin achieved clinical outcomes comparable to nitrofurantoin and was generally well tolerated.

In conclusion, Dr. Melia reinforced that pyuria is a necessary but insufficient criterion for diagnosing UTIs and that clinicians should interpret urinalysis findings alongside symptoms and culture results to avoid unnecessary antibiotic use. He highlighted pivmecillinam and gepotidacin as important new therapeutic options for uncomplicated cystitis.

View a PDF of the webinar summary:
https://www.unboundmedicine.com/ann/webinars/2026/UTI_Update_June_2026_Web...

About The Presenter

Michael Melia, MD

Dr. Michael T. Melia is an Associate Professor of Medicine in the Infectious Diseases (ID) Division at Johns Hopkins. A passionate clinician-educator, he is dedicated to shaping the next generation of medical professionals and has had the privilege of working with learners across all stages of training.

Dr. Melia holds significant education leadership roles, currently serving as Vice Chair for Education in the Department of Medicine and as Director of the ID fellowship training program since July 2015. Previously, he dedicated nine years as an Associate Director in the Osler Internal Medicine Residency Program, where he developed and led the housestaff coaching program. His leadership extends to the broader medical education community, where he chairs the Infectious Diseases Society of America (IDSA) Medical Education Community of Practice, following roles as its Vice Chair (2021-2023) and IDWeek Workgroup Chair (2019-2021). He also chaired the Society’s training program directors’ committee from 2019 through 2021.

Committed to superb, relationship-centered patient care, Dr. Melia dedicates nearly half his time to clinical practice, serving both inpatient and outpatient "general infectious diseases" and HIV services. His research primarily focuses on medical education, and he has cherished the opportunity to mentor, coach, and advise faculty, trainees, and students throughout his career.

FOR MORE INFORMATION

Johns Hopkins Antibiotic (ABX) Guide: https://www.hopkinsguides.com​

Unbound Medicine: https://www.unboundmedicine.com