Purpose <p>Antibiotic use is the main driver of bacterial antimicrobial resistance. Urinary tract infections (UTIs), for which antibiotics are often prescribed, are among the most common infections among residents in nursing homes. This study aimed to estimate and compare the appropriateness of antibiotic use for suspected UTIs among nursing home residents across five European countries. Both the decision to treat and the choice of antibiotics used were explored.</p> Methods <p>This cross-sectional study used the Audit Project Odense (APO) method. The appropriateness of the treatment decision for UTIs was evaluated according to symptom presentation in residents without indwelling urinary catheters. The choice of antibiotic used for treatment was evaluated according to the first-line antibiotic recommended for the treatment of UTIs in the respective countries. Data were collected through an institutional sign-up questionnaire and a clinical case registration chart. All residents in new or ongoing treatment with systemic antibiotics were registered during a 6-week period between February and April 2022.</p> Results <p>A total of 70 nursing homes or wards registered 508 antibiotic treatments for suspected UTIs. The proportion of antibiotics prescribed for UTIs to nursing home residents with no specific UTI symptoms varied from 10% in Poland to 68% in Spain. The proportion of treatments with the first-line choice of antibiotics for UTIs also varied from 28% in France and Poland to 55% in Spain.</p> Conclusion <p>There was a substantial proportion of potentially inappropriate antibiotic treatments, with notable variation among the countries studied.</p>