Questionnaire/history: Sudden onset of fever?

Irritative voiding symptoms (dysuria, frequency, urgency)?

Difficulty passing urine (retention may occur)?

Perineal or suprapubic pain?

Past medical history?

Current medication?

Known drug allergies?

Examination:

Tender prostate on digital rectal examination?

Investigations:

Urine culture?

Consider a sexually transmitted infection screen (particularly in sexually active men younger than 35 years and men with multiple sexual partners or recent partner change)?

Management:

Admit urgently if severely ill, suspected sepsis, in acute urinary retention or suspected abscess (fluctuant swelling on DRE, especially if recent biopsy, catheter or procedure)

Consider urgent referral if immune-compromised or diabetes

Start antibiotics immediately pending urine culture result:

Quinolone (ciprofloxacin 500mg bd or ofloxacin 200mg bd) for 14 days

Review antibiotic choice when culture results available and change according to susceptibility results if the bacteria is resistant using a narrow spectrum wherever possible

If quinolone contraindicated then trimethoprim 200mg bd for 14 days pending MSU results

Paracetamol and/or ibuprofen +/- codeine

Review after 48 hours

Advised to seek urgent medical advice beforehand if he deterioration:

If clinical deterioration, admit

If fails to respond to antibiotics, refer to urology to exclude abscess

If a sexually transmitted infection is suspected, refer to GUM

Review at 14 days and either stop or continue for another 14 days based on clinical assessment

Following recovery refer for an ultrasound to exclude a structural abnormality of the urinary tract

Resource(s):

CKS 2021

NICE October 2018