Urinary tract infection (UTI) is common in the elderly, with a prevalence of approximately 20% in women over 65 years of age. The elderly are predisposed to UTI by anatomic changes in the genitourinary system, by underlying disease, by instrumentation, and by residing in long-term care settings. Indwelling urinary catheters are a frequent cause of UTI, and catheter-associated sepsis is the most common cause of gram-negative sepsis in hospitals. Resistant organisms, prevalent in long-term care settings and hospitals, are increasingly responsible for UTI. Empiric antibiotic therapy has changed with the availability of new agents that cover resistant organisms. Oral antibiotics are appropriate for most UTIs; however, more serious infections require parenteral therapy. Length of antibiotic therapy is generally increased for UTI in the elderly.