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Urinary tract infection (lower) - men - Management
How should I manage lower urinary tract infection in a man without an indwelling urinary catheter?
- Follow local guidelines, when these are available.
- If symptoms are severe (for example severe nausea and vomiting, confusion, tachypnoea, tachycardia, or hypotension), admit the person to hospital; intravenous antibiotics may be required.
- If there is fever or loin pain (or both), manage as upper urinary tract infection (UTI) — see the CKS topic on Pyelonephritis - acute.
- Otherwise, treat for lower UTI:
- Obtain a urine sample for culture and microscopy before starting antibiotic treatment.
- Relieve symptoms with paracetamol or ibuprofen.
- Start empirical treatment with trimethoprim or nitrofurantoin:
- Trimethoprim 200 mg twice daily, for 7 days. Trimethoprim should not be used for empirical treatment if the man has a history of recurrent infections or has taken trimethoprim within the past 12 months.
- Nitrofurantoin 50 mg four times daily, or 100 mg (modified-release) twice daily, for 7 days. The standard formulation is suitable for most people. Consider prescribing the modified-release formulation if nausea has previously been troublesome with the standard formulation, or if adherence with taking medication four times daily is likely to be poor.
- Follow up after 48 hours (or according to the clinical situation) to check response to treatment and the urine culture results.
In depth
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