Randomized Trial of Culture Directed Versus Empiric Antibiotics for Urinary Tract Infections in Older Women

Inclusion Criteria: * Female biologic Sex * Age ≥65 years old * History of recurrent UTI per patient report of greater than 2 UTIs in the last 6 months or 3 UTIs in the last year * Patient reported UTI defined as: * Dysuria, increased urinary urgency/frequency and/or suprapubic pain Exclusion Criteria: * Male biologic sex * Age \<65 years old * History of augmentation cystoplasty or cystectomy * Currently performing clean intermittent self-catheterization * Current indwelling foley catheter * Urinary tract instrumentation (i.e., cystourethroscopy, foley catheter placement) in the last 30 days * Undergoing treatment for malignancy * History of either confirmed or patient reported pyelonephritis and/or urosepsis * Cirrhosis and/or end stage liver disease * Chronic kidney disease with most recent estimated glomerular filtration rate \<50 ml/min * Dementia and/or currently reside in skilled nursing facility * Current high-dose chronic steroids (\>20mg/day of prednisone) * Previous solid organ transplant * Provider concern for pyelonephritis and/or sepsis (i.e., fevers) * Unwilling or unable to comply with study procedures