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Urinary tract infection (lower) - men - Management
How should I manage lower urinary tract infection in a man with an indwelling catheter?

  • Follow local guidelines, when these are available.
  • Do not treat asymptomatic bacteriuria.
  • Considerable clinical judgement is required to diagnose urinary tract infection (UTI) in men with an indwelling urinary catheter.
  • If symptoms are severe (for example severe nausea and vomiting, confusion, tachypnoea, tachycardia, hypotension, reduced urine output), admit the person to hospital; intravenous antibiotics may be required.
  • 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.
  • If there is fever or loin pain (or both), manage as upper UTI. See the CKS topic on Pyelonephritis - acute.
  • Otherwise, treat for lower UTI:
    • Relieve symptoms with paracetamol or ibuprofen.
    • Before starting antibiotic treatment, obtain a urine sample for culture and microscopy.
    • Treat with an antibiotic for 7 days.
    • If symptoms are mild, consider withholding antibiotics until the result of urine culture is available to guide choice of antibiotic.
    • If treatment cannot wait for the culture results, 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.

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