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Urinary tract infection (lower) - men - Management
Overview of management

Men without an indwelling urinary catheter

  • If symptoms are severe, admit the man to hospital.
  • Otherwise, start empirical treatment with trimethoprim or nitrofurantoin for 7 days.
    • Before starting the antibiotic, send a urine sample for culture and microscopy.
    • Local guidelines or local antibiotic resistance patterns may suggest that other antibiotics are more appropriate for empirical treatment.
  • Relieve symptoms with paracetamol or ibuprofen.
  • Review after 48 hours to assess response to treatment, and to check the urine culture results.
  • Exclude or manage risk factors.
  • Do not routinely refer for urological assessment. Refer those men who fail to respond to appropriate treatment or who experience frequent recurrence, and those with features of urinary obstruction, persistent microscopic haematuria, or history of genitourinary tract surgery, pyelonephritis, or calculi.
  • Refer urgently if cancer is suspected.

Men with an indwelling urinary catheter

  • Do not routinely treat asymptomatic bacteriuria. Considerable clinical judgement is required to diagnose urinary tract infection (UTI) in the presence of an indwelling urinary catheter.
  • Admit the man to hospital if there are symptoms and signs of severe infection.
  • Check that the catheter is correctly positioned and is not blocked. If the catheter has been in place for more than a week, consider changing it before starting antibiotic treatment.
  • Relieve symptoms with paracetamol or ibuprofen.
  • Treat with an antibiotic for 7 days.
    • Before starting the antibiotic, send a urine sample for culture and microscopy.
    • If symptoms are mild, consider withholding antibiotics until the urine culture results are available.
    • If treatment cannot wait for the culture results, empirically prescribe trimethoprim or nitrofurantoin.
    • Local guidelines or local antibiotic resistance patterns may suggest that other antibiotics are more appropriate for empirical treatment.
  • When the culture results are available, check the choice of antibiotic, and if necessary change to an antibiotic that the organism is sensitive to.

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