First line:

Co-trimoxazole oral 960mg 12 hourly

Second line:

Ciprofloxacin oral 500mg 12 hourly

N.B. Quinolones like ciprofloxacin have a higher risk of causing C. difficile infection and should not be used empirically for mild infections, in line with the 2019 MHRA warning notice.

Nitrofurantoin does not achieve therapeutic serum or tissue levels and is only used for treatment of uncomplicated lower UTI.

At least 50% of men with recurrent UTI and over 90% of men with febrile UTI have prostate involvement, which may lead to complications such as prostatic abscess or chronic bacterial prostatitis.

• Dipstick testing is not recommended to confirm a diagnosis of UTI in males. Ensure a urine culture is sent to microbiology and adjust treatment accordingly.
• Lower UTI in men can present with any of the following symptoms: frequency, urgency, dysuria, nocturia or suprapubic tenderness.
• Cloudy, dark, or smelly urine is not a sign of UTI. 
• Consider pyelonephritis in patients with fever, rigors, or flank pain / tenderness.
• Consider prostatitis in the differential diagnosis of men with acute dysuria or frequency, and in men with recurrent or febrile UTI. 
• Consider epididymitis and sexually transmitted infections, such as chlamydia and gonorrhoea, in the differential diagnosis of men with acute dysuria or frequency.